Healthcare Provider Details

I. General information

NPI: 1619976388
Provider Name (Legal Business Name): ANDREA NICOLE KWASKY DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 E BIG BEAVER RD STE 201
TROY MI
48083-2054
US

IV. Provider business mailing address

1639 E BIG BEAVER RD STE 201
TROY MI
48083-2054
US

V. Phone/Fax

Practice location:
  • Phone: 248-528-9000
  • Fax: 248-528-9005
Mailing address:
  • Phone: 248-528-9000
  • Fax: 248-528-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704220635
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: