Individual provider Active NPI

Angelica M Mendieta, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Milwaukee, WI
National Provider Identifier
1104613629
Registry record updated Jul 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
16506-33 Issued in WI
Practice address
1032 S Cesar E Chavez Dr
Milwaukee, WI 53204-2203
Phone
(414) 672-1353
Fax
(262) 408-5094
NPI assigned
Apr 21, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 31, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 16506-33 WI Primary

Addresses

Primary practice location

1032 S Cesar E Chavez Dr
Milwaukee, WI 53204-2203

Mailing address

1032 S Cesar E Chavez Dr
Milwaukee, WI 53204-2203
Phone (414) 672-1353

Other practice location 1

4570 S 27th St
Milwaukee, WI 53221-2145
Phone (414) 672-1353

Other practice location 2

2906 S 20th St
Milwaukee, WI 53215-3732
Phone (414) 672-1353

Other practice location 3

309 E North St
Waukesha, WI 53188-3718
Phone (414) 672-1353

Other practice location 4

1635 W National Ave
Milwaukee, WI 53204-1130
Phone (414) 672-1353

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260109002650 WI Practitioner - Nurse Practitioner 9335625201 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
16TH Street Community Health Center Inc.Group PAC ID 6709876857, 83 clinicians

Practice addresses (Care Compare)

1032 S Cesar E Chavez Dr
Milwaukee, WI 53204-2203
Phone (414) 672-1353

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16506-33WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sixteenth Street Community Health Centers, Inc. Nurse Practitioner CurrentSince Oct 20, 2025 Accepting new patients
Sixteenth Street Community Health Centers, Inc. Nurse Practitioner CurrentSince Oct 20, 2025 Accepting new patients

Locations

2906 S 20th St
Milwaukee, WI 53215
Phone (414) 385-8800

1635 W National Ave
Milwaukee, WI 53204
Phone (262) 408-5094

1032 S Cesar E Chavez Dr
Milwaukee, WI 53204

4570 S 27th St
Milwaukee, WI 53221
Phone (414) 325-8720

309 E North St
Waukesha, WI 53188
Phone (262) 408-2530

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1745193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785456000000",
    "number": "1104613629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1032 S CESAR E CHAVEZ DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532042203",
            "telephone_number": "414-672-1353",
            "fax_number": "262-408-5094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 S CESAR E CHAVEZ DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532042203",
            "telephone_number": "414-672-1353",
            "fax_number": "262-408-5094"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4570 S 27th St",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532212145",
            "country_code": "US",
            "telephone_number": "414-672-1353",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2906 S 20th St",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532153732",
            "country_code": "US",
            "telephone_number": "414-672-1353",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "309 E North St",
            "address_purpose": "LOCATION",
            "city": "Waukesha",
            "state": "WI",
            "postal_code": "531883718",
            "country_code": "US",
            "telephone_number": "414-672-1353",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1635 W National Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532041130",
            "country_code": "US",
            "telephone_number": "414-672-1353",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENDIETA",
        "first_name": "ANGELICA",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-04-21",
        "last_updated": "2026-07-31",
        "certification_date": "2026-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "16506-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.