Provider Demographics
NPI:1457324311
Name:ANDRUSZYN, LIDIA MARIA (DNP, FPA APRN, CPC)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:MARIA
Last Name:ANDRUSZYN
Suffix:
Gender:F
Credentials:DNP, FPA APRN, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6348 N MILWAUKEE AVE # 370
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-3728
Mailing Address - Country:US
Mailing Address - Phone:847-507-1548
Mailing Address - Fax:773-792-0946
Practice Address - Street 1:6348 N MILWAUKEE AVE # 370
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-3728
Practice Address - Country:US
Practice Address - Phone:847-507-1548
Practice Address - Fax:773-792-0946
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000162363LG0600X
IL0041195850363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1457324311Medicaid