Andrilyn Nededog, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

209.016674 Issued in IL

Practice address

308 Appleton LN
Lake Villa, IL 60046-6405

Phone

(224) 330-7751

NPI assigned

Oct 11, 2017

Sex

Female

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prowellness Healthcare Inc.

  • Internal Medicine Physician
  • Rancho Cucamonga, CA
  • NPI 1053150698

  CA

  Medicare reassignment NPD
• Vpa PC

  • Family Medicine Physician
  • Oakbrook Terrace, IL
  • NPI 1174925663
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 17, 2017.

{
    "created_epoch": "1507680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508198400000",
    "number": "1952811366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 APPLETON LN",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600466405",
            "telephone_number": "224-330-7751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 APPLETON LN",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600466405",
            "telephone_number": "224-330-7751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEDEDOG",
        "first_name": "ANDRILYN",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-11",
        "last_updated": "2017-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IL",
            "license": "209.016674",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IL",
            "license": "209.016674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caroline Mrowiec, OT
• Sean Barry Murphy
• Lori Jo Murray, M.A., CCC-SLP
• Ryan Naes
• Mohamed E Nasr, M.D.
• Pamela Norley, D.C.
• Northwest Suburban Urgent Care
• Onyeisi Stephen Ogbomeh, DNP, APRN-FPA,FNP-BC
• Rosanne Oggoian, D.O.
• Laura Nancy Ogurek, PSY.D.

• All providers in Lake Villa, IL
• Gerontology Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.