Healthcare Provider Details

I. General information

NPI: 1871824763
Provider Name (Legal Business Name): ANDREA L BILLS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2010
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 ESSEX STREET SUITE 203
HACKENSACK NJ
07601-8566
US

IV. Provider business mailing address

360 ESSEX STREET SUITE 203
HACKENSACK NJ
07601-8566
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-8867
  • Fax: 551-996-8873
Mailing address:
  • Phone: 551-996-8867
  • Fax: 551-996-8873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NO12389700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ01040500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: