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NPI Code Detail

MEDICARE: ANDREA PETERS AGPCNP-C

MEDICARE: ANDREA PETERS AGPCNP-C
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
1363LA2200XAdult Health Nurse Practitioner209014692IL
2363LP2300XPrimary Care Nurse Practitioner209014692IL
3363LG0600XGerontology Nurse Practitioner209014692IL

General Provider Information

NPI Number : 1902356835
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA PETERS AGPCNP-C
Provider Business Mailing Address
First Line : 520 N 4TH ST
Second Line : PO BOX 19639
City : SPRINGFIELD
State : IL
Zip : 62794-9639
Country : US
Telephone Number : 217-545-8000
Fax Number : 217-747-1351
Provider Business Practice Location Address
First Line : 319 E MADISON ST STE 1F
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62701-3118
Country : US
Telephone Number : 217-545-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2016
Last Update Date : 02/09/2023

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