Provider Demographics
NPI:1710240205
Name:CANNELLA, ANDREA LIGNER (RN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LIGNER
Last Name:CANNELLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 SE WASHINGTON ST
Mailing Address - Street 2:APT #327
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4071
Mailing Address - Country:US
Mailing Address - Phone:248-225-4148
Mailing Address - Fax:
Practice Address - Street 1:160 SE WASHINGTON ST
Practice Address - Street 2:APT #327
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4071
Practice Address - Country:US
Practice Address - Phone:248-225-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201240357RN163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health