Healthcare Provider Details

I. General information

NPI: 1659671196
Provider Name (Legal Business Name): ANDREA SIMON LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA JEAN CROWE

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 EAST AVE
AUSTIN TX
78701-4323
US

IV. Provider business mailing address

1430 COLLIER ST
AUSTIN TX
78704-2911
US

V. Phone/Fax

Practice location:
  • Phone: 512-703-1365
  • Fax: 512-804-3457
Mailing address:
  • Phone: 512-472-4357
  • Fax: 512-703-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number228613
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: