Healthcare Provider Details

I. General information

NPI: 1780356782
Provider Name (Legal Business Name): ANDREA C RORABAUGH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S KENNEDY DR STE 900
BRADLEY IL
60915-2683
US

IV. Provider business mailing address

400 S KENNEDY DR STE 900
BRADLEY IL
60915-2683
US

V. Phone/Fax

Practice location:
  • Phone: 815-932-3132
  • Fax: 815-932-2397
Mailing address:
  • Phone: 815-932-3132
  • Fax: 815-932-2397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number209024434
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209024434
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: