Individual
EVAN SHEA MENDOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8201 E RIVERSIDE BLVD, ROCKFORD, IL 61114-2300
(815) 971-7000
Mailing address
5409 EAST DR, LOVES PARK, IL 61111-5025
(773) 744-3643
Taxonomy
Speciality
Code
Description
License number
State
163WF0300X
Flight Registered Nurse
Primary
041517013
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041517013
NURSING LICENSE NUMBER
IL
Enumeration date
05/05/2026
Last updated
05/05/2026
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