Provider Demographics
NPI:1205297868
Name:ANDREWS, AMANDA JULIA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JULIA
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 W CONGRESS PKWY
Mailing Address - Street 2:APT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4396
Mailing Address - Country:US
Mailing Address - Phone:309-310-3288
Mailing Address - Fax:
Practice Address - Street 1:912 S WOOD ST FL MC7994
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4300
Practice Address - Country:US
Practice Address - Phone:312-996-4842
Practice Address - Fax:312-996-9018
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily