| Doctor Name: | MRS. ANNETTA MARIE NORDSTROM |
| NPI Number: | 1295169324 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN, NP-C |
| License Number: | 209.010672 |
| Business Practice Address: | 600 N College Ave Ste 120 Geneseo, IL - 612541092 |
| Business Phone Number: | 3099445342 |
| Business Fax Number: | 3099448192 |
| Mailing Address: | 600 N College Ave Ste 120, GENESEO |
| State: | IL |
| Postal Code: | 612541092 |
| Phone Number: | 3099445342 |
| Fax Number: | 3099448192 |
| NPI Enumeration Date: | 08/26/2013 |
| NPI Last Update Date: | 04/21/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209.010672 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |