Healthcare Provider Details

I. General information

NPI: 1609330596
Provider Name (Legal Business Name): ANDREA JANE HOERR APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E KNOXVILLE ST
BRIMFIELD IL
61517-8022
US

IV. Provider business mailing address

6610 W CHALLACOMBE RD
EDWARDS IL
61528-9739
US

V. Phone/Fax

Practice location:
  • Phone: 309-446-3305
  • Fax:
Mailing address:
  • Phone: 309-696-8543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.018711
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: