Provider Demographics
NPI:1730111832
Name:PLANCK, ANDREA (ANDREA PLANCK RN,BSN)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:PLANCK
Suffix:
Gender:F
Credentials:ANDREA PLANCK RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7137 FORESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-3612
Mailing Address - Country:US
Mailing Address - Phone:513-759-2590
Mailing Address - Fax:
Practice Address - Street 1:7137 FORESTVIEW DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3612
Practice Address - Country:US
Practice Address - Phone:513-759-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN248724163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2242166Medicaid