Active NPI
Evan Shea Mendoza
- Flight Registered Nurse
- Rockford, IL
National Provider Identifier
1861329930
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Flight Registered Nurse
- License
- 041517013
- Practice address
- 8201 E Riverside Blvd
Rockford, IL 61114-2300 - Phone
- (815) 971-7000
- NPI assigned
- May 5, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Flight Registered Nurse | 163WF0300X | 041517013 | IL | Primary |
Addresses
Primary practice location
8201 E Riverside Blvd
Rockford, IL 61114-2300
Mailing address
5409 East Dr
Loves Park, IL 61111-5025
Phone (773) 744-3643
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 041517013 | Other | IL | NURSING LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041517013 | IL | MD | Flight Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1777939200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1777939200000",
"number": "1861329930",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5409 EAST DR",
"city": "LOVES PARK",
"state": "IL",
"postal_code": "611115025",
"telephone_number": "773-744-3643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8201 E RIVERSIDE BLVD",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611142300",
"telephone_number": "815-971-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDOZA",
"first_name": "EVAN",
"middle_name": "SHEA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-05-05",
"last_updated": "2026-05-05",
"certification_date": "2026-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "163WF0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Registered Nurse, Flight",
"state": "IL",
"license": "041517013",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NURSING LICENSE NUMBER",
"identifier": "041517013",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.