Healthcare Provider Details

I. General information

NPI: 1073011821
Provider Name (Legal Business Name): ANDREA MARIE RIZZO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 OGDEN AVE
LISLE IL
60532-1337
US

IV. Provider business mailing address

19W235 GINGER BROOK DR N
OAK BROOK IL
60523-1022
US

V. Phone/Fax

Practice location:
  • Phone: 331-903-1759
  • Fax: 708-246-1109
Mailing address:
  • Phone: 630-479-8273
  • Fax: 708-398-6870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209016633
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: