Healthcare Provider Details

I. General information

NPI: 1295393239
Provider Name (Legal Business Name): ANDREA DEE COONS NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W UNIVERSITY AVE
MUNCIE IN
47303-3428
US

IV. Provider business mailing address

6677 E 400 S
HARTFORD CITY IN
47348-9044
US

V. Phone/Fax

Practice location:
  • Phone: 765-747-3056
  • Fax:
Mailing address:
  • Phone: 765-744-4665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number71008978A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: