Provider Demographics
NPI:1861021057
Name:TROMBETTA, ANDREA MARIE (PA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:TROMBETTA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 W 75TH ST STE 402
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9311
Mailing Address - Country:US
Mailing Address - Phone:630-596-8045
Mailing Address - Fax:630-590-9634
Practice Address - Street 1:1331 W 75TH ST STE 402
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-9311
Practice Address - Country:US
Practice Address - Phone:630-596-8045
Practice Address - Fax:630-590-9634
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.007779363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant