MEDICARE: JEANETTE ANDRADE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian		IL

General Provider Information

NPI Number	:	1700820495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE ANDRADE

Provider Business Mailing Address
First Line	:	822 E KERR AVE
Second Line	:	APT 101
City	:	URBANA
State	:	IL
Zip	:	61802-2045
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PROVENA UNITED SAMARITANS MEDICAL CENTER
Second Line	:	812 N LOGAN AVE
City	:	DANVILLE
State	:	IL
Zip	:	61832-3752
Country	:	US
Telephone Number	:	217-443-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/08/2007

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Directions to “ JEANETTE ANDRADE ” Practice Location

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