Provider Demographics
NPI:1548378409
Name:ANDREWS, DONNA MICHELLE (CNM)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MICHELLE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 896239
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6239
Mailing Address - Country:US
Mailing Address - Phone:803-936-8100
Mailing Address - Fax:
Practice Address - Street 1:222 E MEDICAL LN STE 300
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4848
Practice Address - Country:US
Practice Address - Phone:803-936-8100
Practice Address - Fax:803-936-8130
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1671367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMW0128Medicaid
SCMW0128Medicaid
SCQ32919Medicare ID - Type Unspecified
SC3255Medicare PIN