Healthcare Provider Details

I. General information

NPI: 1356433940
Provider Name (Legal Business Name): ANDREA IANTORNO APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 S RIVER RD
DES PLAINES IL
60018-4103
US

IV. Provider business mailing address

1121 LAKE COOK ROAD SUITE M
DEERFIELD IL
60015-5234
US

V. Phone/Fax

Practice location:
  • Phone: 847-470-8740
  • Fax:
Mailing address:
  • Phone: 847-945-4550
  • Fax: 847-948-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number309001889
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209004590
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: