Healthcare Provider Details

I. General information

NPI: 1093018319
Provider Name (Legal Business Name): ANDREA RENEE HANNON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 FRANK TURK DR
PLAINFIELD IL
60586-8273
US

IV. Provider business mailing address

2908 FRANK TURK DR
PLAINFIELD IL
60586-8273
US

V. Phone/Fax

Practice location:
  • Phone: 630-948-4030
  • Fax: 630-757-7907
Mailing address:
  • Phone: 630-948-4030
  • Fax: 630-757-7907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number847558
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9600450
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95123292
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number041366787
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number041366787
License Number StateIL
# 6
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041366787
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: