Provider Demographics
NPI:1376011403
Name:PUTNAM, ANDREA UNZELMANN (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:UNZELMANN
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LOUISE
Other - Last Name:UNZELMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 BAXTER ST STE 215
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3801
Mailing Address - Country:US
Mailing Address - Phone:704-332-0396
Mailing Address - Fax:
Practice Address - Street 1:9800 KINCEY AVE STE 150
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8405
Practice Address - Country:US
Practice Address - Phone:704-766-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011218363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner