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Individual

ANDREA K MEHLBAUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1340 CHARLES ST, SUITE 200, ROCKFORD, IL 61104-2200
(779) 696-8799
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041348454
IL
363LF0000X
Family Nurse Practitioner
Primary
209016159
IL

Other

Enumeration date
05/11/2017
Last updated
03/02/2021
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