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General NPI Number Information
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NPI Number | 1619976388
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Entity Type | Individual
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Provider Name | ANDREA NICOLE KWASKY DNP
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Gender | Female
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 10/09/2017
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Provider Practice Location Address
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Address Line | 1639 E BIG BEAVER RD STE 201
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City | TROY
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State | MI
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Zip | 48083-2054
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Country | US
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Telephone | 248-528-9000
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Fax | 248-528-9005
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Provider Business Mailing Address
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Address Line | 1639 E BIG BEAVER RD STE 201
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City | TROY
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State | MI
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Zip | 48083-2054
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Country | US
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Telephone | 248-528-9000
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Fax | 248-528-9005
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704220635
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License Number State | MI
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