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NPI Code Detail

MEDICARE: ANDREA E VANDERMOLEN NP

MEDICARE: ANDREA E VANDERMOLEN NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner5662-33WI
2363LA2200XAdult Health Nurse Practitioner5662-33WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134542616
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA E VANDERMOLEN NP
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 800-326-2250
Fax Number :
Provider Business Practice Location Address
First Line : 1155 N HONEY CREEK PKWY
Second Line :
City : WAUWATOSA
State : WI
Zip : 53213-3189
Country : US
Telephone Number : 414-615-5900
Fax Number : 414-615-5927
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2014
Last Update Date : 01/22/2025

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