Provider Demographics
NPI:1740710441
Name:RINDERER, MALLORY (FNP-BC)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:RINDERER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12860 TROXLER AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-2898
Mailing Address - Country:US
Mailing Address - Phone:618-651-2810
Mailing Address - Fax:
Practice Address - Street 1:12860 TROXLER AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-2898
Practice Address - Country:US
Practice Address - Phone:618-651-2810
Practice Address - Fax:618-651-0077
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.016055363LF0000X
IL209016055363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily