Active NPI
Andrea Nelson, LPC, RN
- Registered Nurse
- Rockford, IL
National Provider Identifier
1629344213
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 041.176095
- Practice address
- 3815 Harrison Ave
Rockford, IL 61108-7631 - Phone
- (815) 391-1000
- Fax
- (815) 391-5040
- NPI assigned
- Mar 28, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.006392 | IL | |
| Registered Nurse | 163W00000X | 041.176095 | IL | Primary |
Addresses
Primary practice location
3815 Harrison Ave
Rockford, IL 61108-7631
Mailing address
1021 N Mulford Rd
Rockford, IL 61107-3877
Phone (815) 387-5681
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.006392 | IL | MD | Professional Counselor |
| 041.176095 | IL | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332892800000",
"number": "1629344213",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1021 N MULFORD RD",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611073877",
"telephone_number": "815-387-5681",
"fax_number": "815-391-5041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3815 HARRISON AVE",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611087631",
"telephone_number": "815-391-1000",
"fax_number": "815-391-5040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "ANDREA",
"credential": "LPC, RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-28",
"last_updated": "2012-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.006392",
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IL",
"license": "041.176095",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.