Provider Demographics
NPI:1841734068
Name:DRS
Entity type:Organization
Organization Name:DRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MISS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:ANDE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:618-841-7217
Mailing Address - Street 1:2707 UPCHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:IL
Mailing Address - Zip Code:62930-2344
Mailing Address - Country:US
Mailing Address - Phone:618-841-7217
Mailing Address - Fax:
Practice Address - Street 1:2707 UPCHURCH ST
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-2344
Practice Address - Country:US
Practice Address - Phone:618-841-7217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041395573163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty