Provider Demographics
NPI:1205850278
Name:ANDERSON, DEAN (RN,C-FNP)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:RN,C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:309-672-4809
Mailing Address - Fax:
Practice Address - Street 1:7725 N KNOXVILLE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2079
Practice Address - Country:US
Practice Address - Phone:309-693-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL063750OtherHEALTH ALLIANCE
IL7215059OtherBCBS PPO
ILIL01Q4OtherJOHN DEERE
IL472315OtherHEALTHLINK
IL7215059OtherBCBS PPO
IL472315OtherHEALTHLINK