Individual
ANDREA HENREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1401 E STATE ST, ROCKFORD, IL 61104-2315
(815) 961-2460
Mailing address
PO BOX 1567, ROCKFORD, IL 61110-0067
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041-336785
IL
363L00000X
Nurse Practitioner
Primary
209-014316
IL
Other
Enumeration date
04/25/2016
Last updated
06/07/2016
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