Mae Grace Mendoza
Nurse Practitioner - Adult Health
3880 Salem Lake Dr # F
Long Grove
, Illinois 60047-5292
Mae Grace Mendoza
Nurse Practitioner - Adult Health
3880 Salem Lake Dr # F
Long Grove
, Illinois 60047-5292
(847) 235-3072
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About
Features
Specialties
- Nurse Practitioner - Adult Health
Languages spoken
- English
Location
First Address
- Mae Grace Mendoza
- 3880 Salem Lake Dr # F
- Long Grove, IL
- Zip : 60047-5292
- Phone : (847) 235-3072
Second Address
- Mae Grace Mendoza
- 3880 Salem Lake Dr # F
- Long Grove, IL
- Zip : 60047-5292
- Phone : (847) 235-3072
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LA2200X | Nurse Practitioner - Adult Health | 209014869 | IL |
National Provider Identifier
| NPI | 1023563335 |
|---|---|
| Provider Name | Mae Grace Mendoza |
| First Address | Long Grove, IL 60047-5292 |
| Second Address | Long Grove, IL 60047-5292 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 17/08/2016 |
| Last Update Date | 16/08/2017 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 209014869 | (05) | IL |
| MM4085797 | DEA (01) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.