Healthcare Provider Details

I. General information

NPI: 1285401091
Provider Name (Legal Business Name): ANDREINA URBINA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREINA RAMIREZ

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 W 63RD ST
CHICAGO IL
60629-4605
US

IV. Provider business mailing address

5816 S MEADE AVE
CHICAGO IL
60638-3542
US

V. Phone/Fax

Practice location:
  • Phone: 773-767-2266
  • Fax: 866-493-3835
Mailing address:
  • Phone: 708-655-7289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.029004
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: