Active NPI
Mary E Andris
- Psychiatric/Mental Health Registered Nurse
- Bloomington, IL
National Provider Identifier
1710074414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Registered Nurse
- Practice address
- 108 W Market
Bloomington, IL 61701 - Phone
- (309) 827-5351
- Fax
- (309) 829-6808
- NPI assigned
- Oct 6, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | IL | Primary |
Addresses
Primary practice location
108 W Market
Bloomington, IL 61701
Mailing address
309 E Northtown Rd
Normal, IL 61761
Phone (309) 454-5634
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041156121 | IL | MD | Psychiatric/Mental Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710074414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "309 E NORTHTOWN RD",
"city": "NORMAL",
"state": "IL",
"postal_code": "61761",
"telephone_number": "309-454-5634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 W MARKET",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "61701",
"telephone_number": "309-827-5351",
"fax_number": "309-829-6808"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDRIS",
"first_name": "MARY",
"middle_name": "E",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0808X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.