Provider Demographics
NPI:1558745935
Name:DETWILER, ANDREA (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:DETWILER
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SPARTANBURG HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-5855
Mailing Address - Country:US
Mailing Address - Phone:828-692-4223
Mailing Address - Fax:
Practice Address - Street 1:1200 SPARTANBURG HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5855
Practice Address - Country:US
Practice Address - Phone:828-692-4223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC230575163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant