Provider Demographics
NPI:1538681788
Name:REDIC, ANDREA PAULETTE
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:PAULETTE
Last Name:REDIC
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 1:609 HOGAN ALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5474
Mailing Address - Country:US
Mailing Address - Phone:214-994-6899
Mailing Address - Fax:817-303-1377
Practice Address - Street 1:2141 N COLLINS ST STE 503
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-2812
Practice Address - Country:US
Practice Address - Phone:214-994-6899
Practice Address - Fax:817-303-1377
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty