Provider Demographics
NPI:1114256716
Name:ANDREAE, KRISTEN ELLEN (RN, LAC)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:ELLEN
Last Name:ANDREAE
Suffix:
Gender:F
Credentials:RN, LAC
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:ELLEN
Other - Last Name:MANNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, LAC
Mailing Address - Street 1:105 W N COLLEGE ST
Mailing Address - Street 2:YELLOW SPRINGS
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1500
Mailing Address - Country:US
Mailing Address - Phone:937-479-0075
Mailing Address - Fax:
Practice Address - Street 1:105 W N COLLEGE ST
Practice Address - Street 2:YELLOW SPRINGS
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1500
Practice Address - Country:US
Practice Address - Phone:937-479-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.103571163W00000X
OH65.000112171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse