Healthcare Provider Details

I. General information

NPI: 1124980651
Provider Name (Legal Business Name): ANDREA K HARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S 1200 W
MIDDLEBURY IN
46540-9349
US

IV. Provider business mailing address

1025 S 1200 W
MIDDLEBURY IN
46540-9349
US

V. Phone/Fax

Practice location:
  • Phone: 260-479-8015
  • Fax:
Mailing address:
  • Phone: 260-479-8015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: