Provider Demographics
NPI:1659632917
Name:ROSSOW, ANDREA P (APN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:P
Last Name:ROSSOW
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 1:1415 E STATE ST STE 800
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-2344
Mailing Address - Country:US
Mailing Address - Phone:815-695-6644
Mailing Address - Fax:815-965-2901
Practice Address - Street 1:1415 E STATE ST STE 800
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2344
Practice Address - Country:US
Practice Address - Phone:815-695-6644
Practice Address - Fax:815-965-2901
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily