MEDICARE: ANDREA KASSEM NBC-HWC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist		TX
2	163WX0200X	Oncology Registered Nurse	613927	TX
3	171400000X	Health & Wellness Coach	484728478	TX

General Provider Information

NPI Number	:	1841970811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA KASSEM NBC-HWC

Provider Business Mailing Address
First Line	:	302 LEGEND BREEZE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78260-4317
Country	:	US
Telephone Number	:	210-867-3265
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 MADISON OAK DR STE 450
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4806
Country	:	US
Telephone Number	:	210-730-9610
Fax Number	:	210-730-9693

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/24/2023

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