Provider Demographics
NPI:1447603246
Name:DUDENBOSTEL, MINDY M (CNP)
Entity type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:M
Last Name:DUDENBOSTEL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:MINDY
Other - Middle Name:M
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233-1116
Mailing Address - Country:US
Mailing Address - Phone:618-826-4581
Mailing Address - Fax:
Practice Address - Street 1:1900 STATE ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:IL
Practice Address - Zip Code:62233-1116
Practice Address - Country:US
Practice Address - Phone:618-826-2388
Practice Address - Fax:618-826-5139
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily