Provider Demographics
NPI:1609630185
Name:ANDRE, LISETE (FNTP)
Entity Type:Individual
Prefix:
First Name:LISETE
Middle Name:
Last Name:ANDRE
Suffix:
Gender:F
Credentials:FNTP
Other - Prefix:
Other - First Name:LISETE
Other - Middle Name:
Other - Last Name:ANDRE CLEARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNTP
Mailing Address - Street 1:8021 SEMINOLE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8021 SEMINOLE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3915
Practice Address - Country:US
Practice Address - Phone:917-488-1126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach