Doctor Name: | DR. AUDRA KRYSTELL MENDELSOHN |
NPI Number: | 1053600924 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 01071564A |
Business Practice Address: | 101 Bodin Cir 60mdg/sgoc Travis Afb, CA - 945351809 |
Business Phone Number: | 2065539317 |
Business Fax Number: | |
Mailing Address: | 101 Bodin Cir, 60mdg/sgoc TRAVIS AFB |
State: | CA |
Postal Code: | 945351809 |
Phone Number: | 2065539317 |
Fax Number: | |
NPI Enumeration Date: | 03/31/2011 |
NPI Last Update Date: | 02/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 01071564A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |