Provider Demographics
NPI:1043511629
Name:ANDREW, TIA
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:ANDREW
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 1:7205 LANCELOT PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-6030
Mailing Address - Country:US
Mailing Address - Phone:405-514-8674
Mailing Address - Fax:
Practice Address - Street 1:10400 VINEYARD BLVD STE E
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3830
Practice Address - Country:US
Practice Address - Phone:405-514-8674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator