Provider Demographics
NPI:1457723454
Name:NOFSINGER, ANDREA JEAN (CRNA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JEAN
Last Name:NOFSINGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 N LAKEWOOD AVE
Mailing Address - Street 2:3N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2894
Mailing Address - Country:US
Mailing Address - Phone:309-472-2129
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:UNIVERSITY OF ILLINOIS AT CHICAGO ANESTHESIA DEPT.
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-413-7686
Practice Address - Fax:312-355-4100
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013528367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered