Provider Demographics
NPI:1629724232
Name:EPPING, ANDREA LYNN (RN, BSN, CCM)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:EPPING
Suffix:
Gender:F
Credentials:RN, BSN, CCM
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LYNN
Other - Last Name:HAYWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2130 44TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4521
Mailing Address - Country:US
Mailing Address - Phone:309-373-8572
Mailing Address - Fax:
Practice Address - Street 1:15920 HICKMAN ROAD
Practice Address - Street 2:SUITE 400, PMB 506
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325
Practice Address - Country:US
Practice Address - Phone:309-373-8572
Practice Address - Fax:877-874-2463
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041342428163WC0400X
IA093561163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management