Provider Demographics
NPI:1346677895
Name:TROLI, MANDI ANN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MANDI
Middle Name:ANN
Last Name:TROLI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:MANDI
Other - Middle Name:ANN
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3761 DIXIE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MOMENCE
Mailing Address - State:IL
Mailing Address - Zip Code:60954
Mailing Address - Country:US
Mailing Address - Phone:815-472-3923
Mailing Address - Fax:815-472-2816
Practice Address - Street 1:3761 N STATE ROUTE 1 17
Practice Address - Street 2:
Practice Address - City:MOMENCE
Practice Address - State:IL
Practice Address - Zip Code:60954-2400
Practice Address - Country:US
Practice Address - Phone:815-472-3923
Practice Address - Fax:815-472-2816
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277002012363LP0808X, 363LF0000X
IL041327676163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse