Provider Demographics
NPI:1003291667
Name:MERRELL, ANDREA (LPN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MERRELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:BLOSSVALE
Mailing Address - State:NY
Mailing Address - Zip Code:13308-3630
Mailing Address - Country:US
Mailing Address - Phone:315-761-6806
Mailing Address - Fax:
Practice Address - Street 1:306 20TH AVE
Practice Address - Street 2:
Practice Address - City:BLOSSVALE
Practice Address - State:NY
Practice Address - Zip Code:13308-3630
Practice Address - Country:US
Practice Address - Phone:315-761-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10313326164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse