Individual
JAIME RENEE MENDOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
6805 STATE ROUTE 162 STE 201, MARYVILLE, IL 62062
(618) 288-5019
(618) 288-5059
Mailing address
322 S BUCHANAN ST, EDWARDSVILLE, IL 62025-2086
(618) 498-0190
(618) 417-6049
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209010309
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
27700144
IL
Other
Enumeration date
03/13/2013
Last updated
01/21/2026
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