Provider Demographics
NPI:1619243748
Name:ANDREWS, SUSAN R (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:R
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 CARTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:NY
Mailing Address - Zip Code:14801-9552
Mailing Address - Country:US
Mailing Address - Phone:607-684-8985
Mailing Address - Fax:
Practice Address - Street 1:1716 CARTOWN RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:NY
Practice Address - Zip Code:14801-9552
Practice Address - Country:US
Practice Address - Phone:607-684-8985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306681-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY306681-1OtherNYS LICENSE NUMBER FOR LICENSED PRACTICAL NURSE