Provider Demographics
NPI:1821048372
Name:ANDEL, WILLIAM A (ANP)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:ANDEL
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1005 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2834
Mailing Address - Country:US
Mailing Address - Phone:217-223-8400
Mailing Address - Fax:217-277-3960
Practice Address - Street 1:4800 MAINE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5875
Practice Address - Country:US
Practice Address - Phone:217-214-0444
Practice Address - Fax:217-214-9638
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO139341363LA2200X
IL209004018363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1821048372Medicaid
MOP48679Medicare UPIN
MOE26000001Medicare Oscar/Certification