Reghan L Mulder

Key facts

NPI

1730009978

Entity type

Individual (NPI type 1)

Primary specialty

Athletic Trainer 2255A2300X

License

096.016357 (IL)

Practice address

1 University Cir
Macomb, IL 61455-1390

Phone

(309) 298-1414

NPI assigned

Jul 17, 2026

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 17, 2026.

{
    "created_epoch": "1784246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784246400000",
    "number": "1730009978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1531 W JACKSON ST APT 10",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 UNIVERSITY CIR",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614551390",
            "telephone_number": "309-298-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULDER",
        "first_name": "REGHAN",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-07-17",
        "last_updated": "2026-07-17",
        "certification_date": "2026-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096.016357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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