Individual
MISS ANDREA LYNN MODICA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
327 GUNDERSEN DR, SUITE A, CAROL STREAM, IL 60188-2402
(630) 784-3295
(630) 665-7764
Mailing address
327 GUNDERSEN DR, SUITE A, CAROL STREAM, IL 60188-2402
(630) 784-3295
(630) 665-7764
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041335707
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02233497
BLUE CROSS BLUE SHIELD OF ILLINOIS
IL
Enumeration date
05/05/2010
Last updated
05/05/2010
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