Provider Demographics
NPI:1386038933
Name:IVERSON, ANDREA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:IVERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:IVERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2643 N SPAULDING AVE
Mailing Address - Street 2:UNIT 1W
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1424
Mailing Address - Country:US
Mailing Address - Phone:712-540-5917
Mailing Address - Fax:
Practice Address - Street 1:2643 N SPAULDING AVE
Practice Address - Street 2:UNIT 1W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1424
Practice Address - Country:US
Practice Address - Phone:712-540-5917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-21
Last Update Date:2015-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula