Provider Demographics
NPI:1629592357
Name:RATERMANN, ANDREA MARIE (RN, IL-CSN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:RATERMANN
Suffix:
Gender:F
Credentials:RN, IL-CSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S LAFAYETTE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-2239
Mailing Address - Country:US
Mailing Address - Phone:309-837-3911
Mailing Address - Fax:309-833-2367
Practice Address - Street 1:130 S LAFAYETTE ST STE 201
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-2239
Practice Address - Country:US
Practice Address - Phone:309-837-3911
Practice Address - Fax:309-833-2367
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041342603163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041342603OtherNURSING LICENSE