Healthcare Provider Details

I. General information

NPI: 1588596282
Provider Name (Legal Business Name): MIE LIDY DEBORAH ELIZABETH ANDRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8655 SHADOW RIDGE LN APT G
INDIANAPOLIS IN
46239-8537
US

IV. Provider business mailing address

8655 SHADOW RIDGE LN APT G APT G
INDIANAPOLIS IN
46239-8537
US

V. Phone/Fax

Practice location:
  • Phone: 929-312-1148
  • Fax:
Mailing address:
  • Phone: 929-312-1148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN37795-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: