Provider Demographics
NPI:1710201041
Name:DEFELICE, ANDREA LYNNE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNNE
Last Name:DEFELICE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2323
Mailing Address - Country:US
Mailing Address - Phone:814-490-7993
Mailing Address - Fax:
Practice Address - Street 1:1443 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2323
Practice Address - Country:US
Practice Address - Phone:814-490-7993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY581929163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health