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Individual

ANDREA NELSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC, RN

Contact information

Practice address
3815 HARRISON AVE, ROCKFORD, IL 61108-7631
(815) 391-1000
(815) 391-5040
Mailing address
1021 N MULFORD RD, ROCKFORD, IL 61107-3877
(815) 387-5681
(815) 391-5041

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
178.006392
IL
163W00000X
Registered Nurse
Primary
041.176095
IL

Other

Enumeration date
03/28/2012
Last updated
03/28/2012
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