Basic Information
| Provider Information | |||||||||
| NPI: | 1114590585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OERTLING | ||||||||
| FirstName: | ANDREA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1340 S DAMEN AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606081169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732924800 | ||||||||
| FaxNumber: | 3125644059 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 SAINT CHARLES AVE STE 2562A | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701701000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732924800 | ||||||||
| FaxNumber: | 3125644059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2021 | ||||||||
| LastUpdateDate: | 07/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN135939 | LA | N | Nursing Service Providers | Registered Nurse | 363L00000X | 219952 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 219952 | 01 | LA | CRNP LICENSE | OTHER | RN135939 | 01 | LA | RN LICENSE | OTHER |