Provider Demographics
NPI:1043840184
Name:ANDREWS, MARIAH (LVN)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 GREEN ACRES RD
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76088-8238
Mailing Address - Country:US
Mailing Address - Phone:682-208-7737
Mailing Address - Fax:
Practice Address - Street 1:6115 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5512
Practice Address - Country:US
Practice Address - Phone:817-831-1105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX349954164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse