Provider Demographics
NPI:1962422691
Name:MENDIOLA, LAURIE (CNP, PMHNP-BC, FNP-B)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:MENDIOLA
Suffix:
Gender:F
Credentials:CNP, PMHNP-BC, FNP-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7112 PORTULACA DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2763
Mailing Address - Country:US
Mailing Address - Phone:505-553-2278
Mailing Address - Fax:505-508-1569
Practice Address - Street 1:3150 CARLISLE BLVD NE STE 108
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1680
Practice Address - Country:US
Practice Address - Phone:505-830-6018
Practice Address - Fax:505-830-6025
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR53580363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM44384777Medicaid