Provider Demographics
NPI:1982379459
Name:PAOLELLA, ANDREA ANN
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ANN
Last Name:PAOLELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22W405 JOHN CT
Mailing Address - Street 2:
Mailing Address - City:MEDINAH
Mailing Address - State:IL
Mailing Address - Zip Code:60157-9649
Mailing Address - Country:US
Mailing Address - Phone:630-278-1125
Mailing Address - Fax:
Practice Address - Street 1:759 KANE ST
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-1418
Practice Address - Country:US
Practice Address - Phone:847-697-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program