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General NPI Number Information
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NPI Number | 1982118279
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Entity Type | Individual
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Provider Name | DEANNDRA OLLE APRN
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Gender | Female
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Dates
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Enumeration Date | 11/22/2017
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 1875 DEMPSTER ST STE 665
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City | PARK RIDGE
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State | IL
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Zip | 60068-1168
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Country | US
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Telephone | 847-825-1590
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Fax | 847-825-1604
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Provider Business Mailing Address
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Address Line | 1875 DEMPSTER ST STE 665
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City | PARK RIDGE
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State | IL
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Zip | 60068-1168
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Country | US
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Telephone | 847-825-1590
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Fax | 847-825-1604
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | PENDING
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209016991
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License Number State | IL
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