Provider Demographics
NPI:1790453702
Name:MACHNACKI, ANDREA NOELLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:NOELLE
Last Name:MACHNACKI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11320 N SYCAMORE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:IL
Mailing Address - Zip Code:61525-2518
Mailing Address - Country:US
Mailing Address - Phone:734-637-0186
Mailing Address - Fax:
Practice Address - Street 1:11320 N SYCAMORE CREEK DR
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:IL
Practice Address - Zip Code:61525-2518
Practice Address - Country:US
Practice Address - Phone:734-637-0186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine