MEDICARE: PRINCESS ANDRIANA NELSON

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	246RP1900X	Phlebotomy Technician	N23102921	IL

General Provider Information

NPI Number	:	1427821388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRINCESS ANDRIANA NELSON

Provider Business Mailing Address
First Line	:	230 E OHIO ST STE 410
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-5288
Country	:	US
Telephone Number	:	619-829-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 E OHIO ST STE 410
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-5288
Country	:	US
Telephone Number	:	619-829-3400
Fax Number	:

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

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	11/06/2023

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Directions to “ PRINCESS ANDRIANA NELSON ” Practice Location

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