Healthcare Provider Details

I. General information

NPI: 1841768181
Provider Name (Legal Business Name): ANDREA LYNN HASTINGS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA L WELNICKI APN

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 E NEW YORK ST
AURORA IL
60504-5160
US

IV. Provider business mailing address

18 S MICHIGAN AVE
CHICAGO IL
60603-3200
US

V. Phone/Fax

Practice location:
  • Phone: 630-585-0500
  • Fax:
Mailing address:
  • Phone: 312-592-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.016823
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: