Provider Demographics
NPI:1356727713
Name:JONES, ANDREA REVETHIS (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:REVETHIS
Last Name:JONES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:N
Other - Last Name:REVETHIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:180 HARVESTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6686
Mailing Address - Country:US
Mailing Address - Phone:773-702-9200
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE # MC1130
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily