Provider Demographics
NPI:1265998967
Name:MENDOZA, DAWN I (ARNP, PMHNP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:I
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:ARNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 HEWITT AVE STE 504
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3546
Mailing Address - Country:US
Mailing Address - Phone:425-200-5153
Mailing Address - Fax:
Practice Address - Street 1:1721 HEWITT AVE STE 504
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3546
Practice Address - Country:US
Practice Address - Phone:425-200-5153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61664682363LP0808X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty