Provider Demographics
NPI:1033988555
Name:ACTON, ANDREA L
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:ACTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17213 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-8823
Mailing Address - Country:US
Mailing Address - Phone:573-625-9999
Mailing Address - Fax:
Practice Address - Street 1:17213 TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-8823
Practice Address - Country:US
Practice Address - Phone:573-625-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130699164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse