Provider Demographics
NPI:1093018319
Name:HANNON, ANDREA RENEE (RN)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:RENEE
Last Name:HANNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2908 FRANK TURK DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-8273
Mailing Address - Country:US
Mailing Address - Phone:630-948-4030
Mailing Address - Fax:630-757-7907
Practice Address - Street 1:2908 FRANK TURK DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-8273
Practice Address - Country:US
Practice Address - Phone:630-948-4030
Practice Address - Fax:630-757-7907
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV847558163W00000X
FL9600450163W00000X
CA95123292163W00000X
IL041366787163WC0400X, 163WE0003X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WE0003XNursing Service ProvidersRegistered NurseEmergency