Black, Andrea M

Black, Andrea M is an individual health care provider with primary practice located at 520 Valley View Dr , Moline IL 61265-6194. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Black, Andrea M can be contacted via phone (309) 762-3621.

Contact Information

Primary practice address
520 Valley View Dr Moline IL 61265-6194
Phone: (309) 762-3621
Fax: (309) 762-3690
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 002253 Iowa
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 085.001633 Illinois

Profile Details

NPI number 1487922738
LBN Legal business name Black, Andrea M
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 1st, 2011
Last updated Feb 13th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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