NICOLE RAE MENDOZA (NPI# 1649638974) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649638974 |
| Entity Type | Individual |
| Full Name | NICOLE RAE MENDOZA |
| Credential | RN, MSN, FNP |
| Practice Address |
329 S Ivy St Medford OR 97501-3174 |
| Practice Telephone | 5418977383 |
| Practice Fax Number | 5413209023 |
| Mailing Telephone | 5418977383 |
| Mailing Fax Number | 5413209023 |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2020-01-16 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
201508266NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
201508266NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
201508266NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1840 E Barnett Rd, Suite B, Medford, OR 97504 | 5418977383 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265047922 | Nicole Mendoza | Behavior Technician | 7529 Standish Pl Ste 355, Derwood, MD 20855-2733 | 2020-09-10 |
| 1730732124 | Nicole Mendoza | Behavior Technician | 2970 Hilltop Mall Rd Ste. 104, Richmond, CA 94806-9480 | 2019-07-24 |
| 1801302179 | Nicole M Mendoza | Counselor | 1300 N 17th Ave, Greeley, CO 80631-9584 | 2017-12-21 |
| 1538199203 | Nicole Lea Mendoza | Anesthesiologist Assistant | 3001 W. Dr. Martin Luther King Jr. Blvd., Tampa, FL 33607-6307 | 2006-07-05 |
| Street Address |
329 S IVY ST |
| City | MEDFORD |
| State | OR |
| Zip Code | 97501-3174 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225106651 | Brian Jared Smith | Chiropractor | 329 S Ivy St, Medford, OR 97501-3174 | 2006-12-01 |
| 1649629734 | Meridian Wellness Center | Clinic/Center | 329 S Ivy St, Medford, OR 97501-3174 | 2016-06-08 |
| 1912399171 | Brian J Smith, Dc | Chiropractor | 329 S Ivy St, Medford, OR 97501-3174 | 2015-02-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366069494 | Brian Snapp | Counselor | 1191 Hazel St, Medford, OR 97501 | 2020-07-06 |
| 1477174761 | Corey Renfree | Counselor | 1191 Hazel Street, Medford, OR 97501 | 2020-04-28 |
| 1669012928 | One of A Kind Therapy LLC | Social Worker | 916 West 10th St #205, Medford, OR 97501 | 2020-01-14 |
| 1265993620 | Star Dialysis LLC | Clinic/Center | 50 Rossanley Dr, Medford, OR 97501 | 2019-03-28 |
| 1962972463 | Karen Elise Roertgen | Counselor | 328 So. Central Ave., Suite 204, Medford, OR 97501 | 2018-11-28 |
| 1316458813 | Rick's Medical Supply, Inc | Durable Medical Equipment & Medical Supplies | 562 Parsons Drive, Suite 114, Medford, OR 97501 | 2017-10-24 |
| 1750807111 | La Clinica Del Valle Family Health Care Center Inc. | Clinic/Center | 821 N Riverside Ave, Medford, OR 97501 | 2017-08-17 |
| 1992229009 | Cassandra Schultz | Massage Therapist | 824 East Jackson, Suite A, Medford, OR 97501 | 2017-07-31 |
| 1972962355 | Robin Clevenger | Peer Specialist | 301 S Ivy St, Medford, OR 97501 | 2016-02-15 |
| 1154706984 | Debbie Diane Orr | Behavioral Analyst | 1024 West 9th Street, Medford, OR 97501 | 2015-07-22 |
| Find all providers in zip 97501 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699761932 | Rogue Valley Physicians | Nurse Practitioner | 2900 Doctors Park Dr, Medford, OR 97504-8127 | 2005-09-22 |
| 1497376826 | Stacey Andrews | Nurse Practitioner | 1307 W Main St, Medford, OR 97501-2936 | 2020-04-27 |
| 1528532108 | Christina Renee Martin | Nurse Practitioner | 691 Murphy Rd Ste 107, Medford, OR 97504 | 2019-01-16 |
| 1942749833 | Laura Breu | Nurse Practitioner | 3617 S Pacific Hwy, Medford, OR 97501-8957 | 2017-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154956233 | Ellen Faye Barlow | Nurse Practitioner | 506 Fourth St., La Grande, OR 97850 | 2020-03-09 |
| 1225698889 | Agewell Geriatrics, LLC | Nurse Practitioner | 13120 Sw Heather Ct, Beaverton, OR 97008-5612 | 2019-06-17 |
| 1760960462 | Sid Christian Keomanivong | Nurse Practitioner | 2677 Beall Ln, Central Point, OR 97502-1462 | 2018-08-03 |
| 1245611771 | Karen Musick | Nurse Practitioner | 3514 Nw Mckinley Dr, Corvallis, OR 97330-1148 | 2015-06-10 |
| 1184054546 | Nancy M Burgess Rn Msn Anp-c PC | Nurse Practitioner | 910 Sw Highway 97 Ste 104, Madras, OR 97741-9247 | 2013-11-22 |
| 1518391804 | Sally Elizabeth Kraynik | Nurse Practitioner | 1895 E Main St, Hillsboro, OR 97123-4345 | 2013-08-22 |
| 1295998920 | Paula Jo Cramer | Nurse Practitioner | 790 S Main St Myrtle, Creek, Ore, Myrtle Creek, OR 97457 | 2008-07-02 |
| 1780855601 | Leslie West | Nurse Practitioner | 51730 Dexter St., Blue River, OR 97413-0183 | 2008-03-19 |
| 1548399322 | Corporate Health Nw | Nurse Practitioner | 10209 Se Division St, Portland, OR 97266-1327 | 2007-03-05 |
| 1962540310 | Laura Ann Shattuck | Nurse Practitioner | 21440 S Upper Highland Rd, Beavercreek, OR 97004-8814 | 2007-02-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.