MAE GRACE MENDOZA (NPI# 1023563335) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023563335 |
| Entity Type | Individual |
| Full Name | MAE GRACE MENDOZA |
| Credential | APN |
| Practice Address |
3880 Salem Lake Dr # F Long Grove IL 60047-5292 |
| Practice Telephone | 8472353072 |
| Mailing Telephone | 8472353072 |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2017-08-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 041356399 | IL | Nursing Service Providers |
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
209014869 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | DEA | MM4085797 | 01 |
| IL | 209014869 | 05 |
| Street Address |
3880 SALEM LAKE DR # F |
| City | LONG GROVE |
| State | IL |
| Zip Code | 60047-5292 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053323881 | Annette Corinne Olin | Internal Medicine | 3880 Salem Lake Dr # F, Long Grove, IL 60047 | 2006-08-12 |
| 1306370838 | Corrin Miranda | Nurse Practitioner | 3880 Salem Lake Dr # F, Long Grove, IL 60047 | 2017-04-11 |
| 1073972188 | Rebecca Lynne Smith | Nurse Practitioner | 3880 Salem Lake Dr # F, Long Grove, IL 60047 | 2016-02-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871142547 | Terry Solberg | Technician | 25 Robin Crest Rd, Hawthorn Woods, IL 60047 | 2019-09-05 |
| 1073083614 | Cody Colleen Todd | Counselor | 21361 W Brandon Rd, Kildeer, IL 60047 | 2018-11-27 |
| 1861983694 | Ahmad Family Primary Care, S.c. | Family Medicine | 350 Surryse Rd Ste 240, Lake Zurich, IL 60047 | 2018-05-29 |
| 1508371972 | Joy Anne Margolis | Speech-Language Pathologist | 4151 Robert Parker Coffin Rd, Long Grove, IL 60047 | 2017-12-07 |
| 1982118576 | Stephanie Marie Luebbe | Specialist/Technologist | 30 Seneca Ave W, Hawthorn Woods, IL 60047 | 2017-11-19 |
| 1447785498 | Kayla Stavnes | Student in an Organized Health Care Education/Training Program | 23537 N Garden Ln, Lake Zurich, IL 60047 | 2017-04-27 |
| 1104366491 | Lindsay Pearlman & Associates | Psychologist | 4160 Rte 83, Suite 307, Long Grove, IL 60047 | 2017-03-06 |
| 1164969929 | Lauren Christine Hallerud | Counselor | 4180 Il-83, Suite 10, Long Grove, IL 60047 | 2017-01-31 |
| 1790220820 | Long Grove Center for Emotional Health LLC | Counselor | 4180 Rfd, Suite 10, Long Grove, IL 60047 | 2016-12-28 |
| 1063960276 | Mars Healthcare LLC | Clinic/Center | 721 W Highway 22nd, Lake Zurich, IL 60047 | 2016-09-16 |
| Find all providers in zip 60047 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215492491 | Jakeyla Reed | Nurse Practitioner | 3880 Salem Lake Dr Ste F, Long Grove, IL 60047 | 2019-02-01 |
| 1790258473 | Punam Subhashchandra Trivede | Nurse Practitioner | 3880 Salem Lake Dr Ste F, Long Grove, IL 60047-5292 | 2019-01-06 |
| 1033694922 | Helen E Okorie | Nurse Practitioner | 3880 Salem Lake Dr Ste F, Long Grove, IL 60047 | 2018-09-26 |
| 1376024976 | Agnieszka Nieciunski | Nurse Practitioner | 3880 Salem Lake Dr Ste F, Long Grove, IL 60047-5292 | 2018-08-22 |
| 1336627165 | Lana Bratko | Nurse Practitioner | 3880 Salem Lake Dr Ste F, Long Grove, IL 60047-5292 | 2018-08-02 |
| 1265919112 | Christine Laverne Bolden | Nurse Practitioner | 3880 Salem Lake Dr Ste F, Long Grove, IL 60047 | 2018-07-24 |
| 1861979189 | Jessica Roche | Nurse Practitioner | 3880 Salem Lake Dr Ste F, Long Grove, IL 60047 | 2018-07-20 |
| 1992291348 | Songquan Jiang | Nurse Practitioner | 3880 Salem Lake Dr Ste F, Long Grove, IL 60047-5292 | 2018-07-09 |
| 1801387089 | Tarryn Ellis | Nurse Practitioner | 3880 Salem Lake Dr Ste F, Long Grove, IL 60047 | 2018-05-23 |
| 1548757552 | Magdalena Mcmeekin | Nurse Practitioner | 3880 Salem Lake Dr Ste F, Long Grove, IL 60047-5292 | 2018-04-16 |
| Find all providers in LONG GROVE | ||||
| City | LONG GROVE |
| Zip Code | 60047 |
Please comment or provide details below to improve the information on MAE GRACE MENDOZA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.