Healthcare Provider Details

I. General information

NPI: 1316426190
Provider Name (Legal Business Name): ANDREA JORDAN ALPERTO RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2018
Last Update Date: 08/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

2910 N MASON AVE
CHICAGO IL
60634-5136
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-8387
  • Fax:
Mailing address:
  • Phone: 312-363-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number041350597
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041350597
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: