Provider Demographics
NPI:1356669022
Name:MODICA, ANDREA LYNN (RN)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:LYNN
Last Name:MODICA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:327 GUNDERSEN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2402
Mailing Address - Country:US
Mailing Address - Phone:630-784-3295
Mailing Address - Fax:630-665-7764
Practice Address - Street 1:327 GUNDERSEN DR
Practice Address - Street 2:SUITE A
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2402
Practice Address - Country:US
Practice Address - Phone:630-784-3295
Practice Address - Fax:630-665-7764
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041335707163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02233497OtherBLUE CROSS BLUE SHIELD OF ILLINOIS