Healthcare Provider Details

I. General information

NPI: 1649112152
Provider Name (Legal Business Name): ALEXANDRA ANDERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 N MOBILE AVE
CHICAGO IL
60634-4041
US

IV. Provider business mailing address

4843 W BERTEAU AVE
CHICAGO IL
60641-1602
US

V. Phone/Fax

Practice location:
  • Phone: 773-622-5679
  • Fax:
Mailing address:
  • Phone: 773-622-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209034295
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: