Provider Demographics
NPI:1366549420
Name:MENDELSBERG, CARRIE A (ARNP)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:A
Last Name:MENDELSBERG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1459
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-1459
Mailing Address - Country:US
Mailing Address - Phone:478-538-0908
Mailing Address - Fax:
Practice Address - Street 1:315 E BROADWAY
Practice Address - Street 2:4TH FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1703
Practice Address - Country:US
Practice Address - Phone:502-629-2500
Practice Address - Fax:502-629-3166
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1074863363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1074863OtherKY RN LICENSE