Provider Demographics
NPI:1659606051
Name:FONSECA, ANDREA LAUREN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LAUREN
Last Name:FONSECA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ANGELICA AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-2246
Mailing Address - Country:US
Mailing Address - Phone:508-994-4652
Mailing Address - Fax:
Practice Address - Street 1:2621 CRANBERRY HWY
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1004
Practice Address - Country:US
Practice Address - Phone:508-295-4902
Practice Address - Fax:508-295-2455
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN260771363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health