Active NPI
Eunice Joan Mennenoh, PA
- Physician Assistant
- Audubon, IA
National Provider Identifier
1073573804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 001959
- Practice address
- 515 Pacific Ave
Audubon, IA 50025-1056 - Phone
- (712) 563-2611
- Fax
- (712) 563-3078
- NPI assigned
- Mar 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 001959 | IA | Primary |
Addresses
Primary practice location
515 Pacific Ave
Audubon, IA 50025-1056
Mailing address
515 Pacific Ave
Audubon, IA 50025-1056
Phone (712) 563-2611
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2033 | AZ | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252972800000",
"number": "1073573804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "515 PACIFIC AVE",
"city": "AUDUBON",
"state": "IA",
"postal_code": "500251056",
"telephone_number": "712-563-2611",
"fax_number": "712-563-3078"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 PACIFIC AVE",
"city": "AUDUBON",
"state": "IA",
"postal_code": "500251056",
"telephone_number": "712-563-2611",
"fax_number": "712-563-3078"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENNENOH",
"first_name": "EUNICE",
"middle_name": "JOAN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-24",
"last_updated": "2009-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IA",
"license": "001959",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Audubon, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.