Healthcare Provider Details

I. General information

NPI: 1508225012
Provider Name (Legal Business Name): ANDREA TIPPINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 E GRAND BLVD
DETROIT MI
48202-3133
US

IV. Provider business mailing address

2995 E GRAND BLVD
DETROIT MI
48202-3133
US

V. Phone/Fax

Practice location:
  • Phone: 313-308-0255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: