Healthcare Provider Details

I. General information

NPI: 1770748089
Provider Name (Legal Business Name): ANDREA E PARKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25059 STONYCROFT DR
SOUTHFIELD MI
48033-2717
US

IV. Provider business mailing address

25059 STONYCROFT DR
SOUTHFIELD MI
48033-2717
US

V. Phone/Fax

Practice location:
  • Phone: 313-414-5998
  • Fax: 248-212-0193
Mailing address:
  • Phone: 313-414-5998
  • Fax: 248-212-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number4704100545
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: