Provider Demographics
NPI:1407930696
Name:FLEENOR, ANDREA ELAINE (RD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ELAINE
Last Name:FLEENOR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:ELAINE
Other - Last Name:FAVREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:6921 W GORE BLVD
Mailing Address - Street 2:#516
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5330
Mailing Address - Country:US
Mailing Address - Phone:580-458-3055
Mailing Address - Fax:580-458-2846
Practice Address - Street 1:4301 MOW-WAY ROAD
Practice Address - Street 2:REYNOLDS ARMY COMMUNITY HOSPITAL (MCUA-QC, MS.PRESCOTT)
Practice Address - City:FT. SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-6300
Practice Address - Country:US
Practice Address - Phone:580-458-2134
Practice Address - Fax:580-458-2314
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered