MEDICARE: ANDREA L RYAN APN-CNP

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
1	363L00000X	Nurse Practitioner	209008096	IL
2	363LP0200X	Pediatric Nurse Practitioner	209008096	IL

General Provider Information

NPI Number	:	1184900144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA L RYAN APN-CNP

Provider Business Mailing Address
First Line	:	2011 N LARRABEE ST # 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4418
Country	:	US
Telephone Number	:	773-750-6451
Fax Number	:

Provider Business Practice Location Address
First Line	:	5145 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3661
Country	:	US
Telephone Number	:	773-878-8200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2011
Last Update Date	:	05/07/2026

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