Provider Demographics
NPI:1073821187
Name:REISCHERL, ANDREA CELENE (APRN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CELENE
Last Name:REISCHERL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 HYDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH FRANKLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06254-1002
Mailing Address - Country:US
Mailing Address - Phone:860-848-5874
Mailing Address - Fax:860-848-5802
Practice Address - Street 1:986 NORWICH NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-1928
Practice Address - Country:US
Practice Address - Phone:860-848-5874
Practice Address - Fax:860-848-5802
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE56717163W00000X
CTE56717163W00000X
CT002533364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse