Provider Demographics
NPI:1316539356
Name:DIDENKO, ANDRE (FNP)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:DIDENKO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 N PLAZA DR STE 270
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5493
Mailing Address - Country:US
Mailing Address - Phone:847-496-4525
Mailing Address - Fax:847-660-2958
Practice Address - Street 1:999 N PLAZA DR STE 270
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5493
Practice Address - Country:US
Practice Address - Phone:847-496-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022735363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner