Individual
ANDREA E VANDERMOLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1155 N HONEY CREEK PKWY, WAUWATOSA, WI 53213-3189
(414) 615-5900
(414) 615-5927
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5662-33
WI
363LA2200X
Adult Health Nurse Practitioner
5662-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100049650
—
WI
05
—
1134542616
—
WI
Enumeration date
02/04/2014
Last updated
01/22/2025
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