Provider Demographics
NPI:1093201774
Name:ANDREWS-DABNEY, LAJOY
Entity Type:Individual
Prefix:
First Name:LAJOY
Middle Name:
Last Name:ANDREWS-DABNEY
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 1:1631 MCLARAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63147-1333
Mailing Address - Country:US
Mailing Address - Phone:314-941-9911
Mailing Address - Fax:314-787-4529
Practice Address - Street 1:3156 PERSHALL RD STE 132
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-4406
Practice Address - Country:US
Practice Address - Phone:314-941-9911
Practice Address - Fax:314-787-4529
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No172A00000XOther Service ProvidersDriver
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO82-1896788Medicaid