Provider Demographics
NPI:1427036110
Name:ANDREONI, COLLEEN PATRICIA (APN)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:PATRICIA
Last Name:ANDREONI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3315
Mailing Address - Country:US
Mailing Address - Phone:630-315-6700
Mailing Address - Fax:630-315-6699
Practice Address - Street 1:100 GORE RD
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-9466
Practice Address - Country:US
Practice Address - Phone:815-364-8919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-004807363L00000X
IL209004807364SA2200X
IL209 004807363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209004807Medicaid
IL209004807Medicaid