Provider Demographics
NPI:1093125197
Name:STEIDL, ANDREW
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:STEIDL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:
Other - Last Name:STEIDL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:224 OLD MILL RD
Mailing Address - Street 2:PO BOX 408
Mailing Address - City:WARTBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37887-4163
Mailing Address - Country:US
Mailing Address - Phone:423-346-6221
Mailing Address - Fax:423-346-3447
Practice Address - Street 1:224 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-4163
Practice Address - Country:US
Practice Address - Phone:423-346-6221
Practice Address - Fax:423-346-3447
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18631363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily