1629724232 NPI number — ANDREA LYNN EPPING RN, BSN, CCM

Table of content: ANDREA LYNN EPPING RN, BSN, CCM (NPI 1629724232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629724232 NPI number — ANDREA LYNN EPPING RN, BSN, CCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EPPING
Provider First Name:
ANDREA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN, CCM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAYWOOD
Provider Other First Name:
ANDREA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629724232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2130 44TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOLINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61265-4521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-373-8572
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15920 HICKMAN ROAD
Provider Second Line Business Practice Location Address:
SUITE 400, PMB 506
Provider Business Practice Location Address City Name:
CLIVE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-373-8572
Provider Business Practice Location Address Fax Number:
877-874-2463
Provider Enumeration Date:
02/23/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC0400X , with the licence number:  041342428 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WC0400X , with the licence number: 093561 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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