Provider Demographics
NPI:1104080779
Name:WINKING, ANDREA LOUISE (RN BSN)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LOUISE
Last Name:WINKING
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:LOUISE
Other - Last Name:MACKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN BSN
Mailing Address - Street 1:2323 WINDISH DRIVE
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401
Mailing Address - Country:US
Mailing Address - Phone:309-344-2323
Mailing Address - Fax:309-344-4368
Practice Address - Street 1:2323 WINDISH DRIVE
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401
Practice Address - Country:US
Practice Address - Phone:309-734-9461
Practice Address - Fax:309-344-4368
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041322441163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse