MEDICARE: ANDREA NICHOL SASH LVN

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	164X00000X	Licensed Vocational Nurse	306358	TX

General Provider Information

NPI Number	:	1851129134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA NICHOL SASH LVN

Provider Business Mailing Address
First Line	:	7138 GATEWOOD DR
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-4901
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2236 BROUSSARD ST
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-8485
Country	:	US
Telephone Number	:	430-287-1896
Fax Number	:

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

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	07/26/2024

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