Provider Demographics
NPI:1679670533
Name:ANDEM, MARGARET I (ARNP, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:I
Last Name:ANDEM
Suffix:
Gender:F
Credentials:ARNP, LCSW
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 844
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32447-0844
Mailing Address - Country:US
Mailing Address - Phone:850-573-2233
Mailing Address - Fax:850-482-2079
Practice Address - Street 1:4396 LAFAYETTE ST
Practice Address - Street 2:SUITE 209
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-3356
Practice Address - Country:US
Practice Address - Phone:850-573-2233
Practice Address - Fax:850-482-2079
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9308448363LP0808X, 363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0M3ZOtherBLUE CROSS BLUE SHIELD
FL010527600Medicaid
FL7679670 00Medicaid
AL592 01021OtherBCBS ALABAMA
AL592 01021OtherBCBS ALABAMA
AL592 01021OtherBCBS ALABAMA