Provider Demographics
NPI:1033756341
Name:DAVIES, ANDREA VENUS (NP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:VENUS
Last Name:DAVIES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:PROF
Other - First Name:ANDREA
Other - Middle Name:VENUS
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7084
Mailing Address - Fax:
Practice Address - Street 1:4320 FIR ST UNIT 313
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3078
Practice Address - Country:US
Practice Address - Phone:219-392-7424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28180308A163W00000X
IN71009851A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse