Healthcare Provider Details

I. General information

NPI: 1255934378
Provider Name (Legal Business Name): WHITNEY RENEE ANDAL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 N KNOXVILLE AVE
PEORIA IL
61614-5016
US

IV. Provider business mailing address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

V. Phone/Fax

Practice location:
  • Phone: 309-624-9960
  • Fax:
Mailing address:
  • Phone: 93-655-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021067
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: