Healthcare Provider Details

I. General information

NPI: 1639635972
Provider Name (Legal Business Name): TAMMY ANDES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W WASHINGTON ST STE 1
NEWTON IL
62448
US

IV. Provider business mailing address

1207 NETWORK CENTRE DR STE 3
EFFINGHAM IL
62401-4632
US

V. Phone/Fax

Practice location:
  • Phone: 618-783-0954
  • Fax: 618-783-0958
Mailing address:
  • Phone: 217-347-2707
  • Fax: 217-347-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041446908
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209018907
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: