Provider Demographics
NPI:1538398870
Name:BATTLES, MANDI LISETTE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MANDI
Middle Name:LISETTE
Last Name:BATTLES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 769
Mailing Address - Street 2:101 WEST COAST ROAD
Mailing Address - City:REDWAY
Mailing Address - State:CA
Mailing Address - Zip Code:95560
Mailing Address - Country:US
Mailing Address - Phone:707-923-2783
Mailing Address - Fax:707-923-2543
Practice Address - Street 1:101 WEST COAST ROAD
Practice Address - Street 2:
Practice Address - City:REDWAY
Practice Address - State:CA
Practice Address - Zip Code:95560
Practice Address - Country:US
Practice Address - Phone:707-923-2783
Practice Address - Fax:707-923-2543
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 20367363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical