Provider Demographics
NPI:1053581348
Name:SCOTT-MENDOZA, KRISTINA FARRAH
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:FARRAH
Last Name:SCOTT-MENDOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:FARRAH
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:R N
Mailing Address - Street 1:333 8TH ST SE APT 321
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1255
Mailing Address - Country:US
Mailing Address - Phone:651-328-1823
Mailing Address - Fax:
Practice Address - Street 1:333 8TH ST SE APT 321
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1255
Practice Address - Country:US
Practice Address - Phone:651-328-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine