Provider Demographics
NPI:1710483441
Name:REDD, ANDREA HEATHER (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:HEATHER
Last Name:REDD
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 1:5935 FESCUE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-7534
Mailing Address - Country:US
Mailing Address - Phone:719-233-5365
Mailing Address - Fax:
Practice Address - Street 1:5935 FESCUE DRIVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-7534
Practice Address - Country:US
Practice Address - Phone:719-233-5365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0125418208D00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice