Healthcare Provider Details

I. General information

NPI: 1780883751
Provider Name (Legal Business Name): ANDREA DAWN CUMMINGS B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W STEVE OWENS BLVD
MIAMI OK
74354-7629
US

IV. Provider business mailing address

411 EASTGATE BLVD
MIAMI OK
74354-7316
US

V. Phone/Fax

Practice location:
  • Phone: 918-542-2845
  • Fax: 918-542-2848
Mailing address:
  • Phone: 918-540-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: