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NPI Code Detail

MEDICARE: EVAN SHEA MENDOZA

MEDICARE: EVAN SHEA MENDOZA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WF0300XFlight Registered Nurse041517013IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1041517013OTHERILNURSING LICENSE NUMBER

General Provider Information

NPI Number : 1861329930
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVAN SHEA MENDOZA
Provider Business Mailing Address
First Line : 5409 EAST DR
Second Line :
City : LOVES PARK
State : IL
Zip : 61111-5025
Country : US
Telephone Number : 773-744-3643
Fax Number :
Provider Business Practice Location Address
First Line : 8201 E RIVERSIDE BLVD
Second Line :
City : ROCKFORD
State : IL
Zip : 61114-2300
Country : US
Telephone Number : 815-971-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2026
Last Update Date : 05/05/2026

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Directions to “ EVAN SHEA MENDOZA ” Practice Location

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