Healthcare Provider Details

I. General information

NPI: 1114590585
Provider Name (Legal Business Name): ANDREA OERTLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SAINT CHARLES AVE STE 2562A
NEW ORLEANS LA
70170-1000
US

IV. Provider business mailing address

1340 S DAMEN AVE STE 400
CHICAGO IL
60608-1169
US

V. Phone/Fax

Practice location:
  • Phone: 773-292-4800
  • Fax: 312-564-4059
Mailing address:
  • Phone: 773-292-4800
  • Fax: 312-564-4059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number219952
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN135939
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: