Provider Demographics
NPI:1639635972
Name:ANDES, TAMMY (APRN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:ANDES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 NETWORK CENTRE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4632
Mailing Address - Country:US
Mailing Address - Phone:217-347-2707
Mailing Address - Fax:217-347-2827
Practice Address - Street 1:601 W WASHINGTON ST STE 1
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IL
Practice Address - Zip Code:62448
Practice Address - Country:US
Practice Address - Phone:618-783-0954
Practice Address - Fax:618-783-0958
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041446908163W00000X
IL209018907363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse