Provider Demographics
NPI:1023043700
Name:ANDREWS, LAURA M
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:M
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:G
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1947
Mailing Address - Street 2:1996 S. OTSEGO
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49734-5947
Mailing Address - Country:US
Mailing Address - Phone:989-705-2669
Mailing Address - Fax:989-705-2608
Practice Address - Street 1:1996 S OTSEGO AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-8381
Practice Address - Country:US
Practice Address - Phone:989-705-2669
Practice Address - Fax:989-705-2608
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3118873Medicaid
MI3118873Medicaid