Provider Demographics
NPI:1710920962
Name:ANDREONI, VICKI ANN (DNP, RN, CPNP)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:ANN
Last Name:ANDREONI
Suffix:
Gender:F
Credentials:DNP, RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S PECK AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2171
Mailing Address - Country:US
Mailing Address - Phone:708-352-2742
Mailing Address - Fax:
Practice Address - Street 1:807 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-2307
Practice Address - Country:US
Practice Address - Phone:708-449-9529
Practice Address - Fax:708-449-9525
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001982363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics