Provider Demographics
NPI:1629797527
Name:DEWINTER, ANDREA MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:DEWINTER
Suffix:
Gender:F
Credentials:FNP-BC
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 93
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TN
Mailing Address - Zip Code:37096-0093
Mailing Address - Country:US
Mailing Address - Phone:616-350-0960
Mailing Address - Fax:
Practice Address - Street 1:314 POPLIN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TN
Practice Address - Zip Code:37096-6251
Practice Address - Country:US
Practice Address - Phone:616-350-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily