Provider Demographics
NPI:1407119449
Name:MCANDREWS, SUSAN DIANE (LPN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANE
Last Name:MCANDREWS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W CORTLAND ST
Mailing Address - Street 2:BOX 147
Mailing Address - City:GROTON
Mailing Address - State:NY
Mailing Address - Zip Code:13073-1011
Mailing Address - Country:US
Mailing Address - Phone:607-898-5889
Mailing Address - Fax:
Practice Address - Street 1:405 W CORTLAND ST
Practice Address - Street 2:BOX 147
Practice Address - City:GROTON
Practice Address - State:NY
Practice Address - Zip Code:13073-1011
Practice Address - Country:US
Practice Address - Phone:607-898-5889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089435-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse