Provider Demographics
NPI:1538534136
Name:MENDENHALL, JOSEPH DEAL
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DEAL
Last Name:MENDENHALL
Suffix:
Gender:M
Credentials:
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 307
Mailing Address - Street 2:5008 MADRONA BEACH LN KP N
Mailing Address - City:VAUGHN
Mailing Address - State:WA
Mailing Address - Zip Code:98394-0307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5008 MADRONA BEACH LN KP N
Practice Address - Street 2:
Practice Address - City:VAUGHN
Practice Address - State:WA
Practice Address - Zip Code:98394-0307
Practice Address - Country:US
Practice Address - Phone:253-549-5119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic