Provider Demographics
NPI:1770835712
Name:ANDREWS, BREANNA (LPN)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 TIMBER TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2121
Mailing Address - Country:US
Mailing Address - Phone:631-346-7242
Mailing Address - Fax:
Practice Address - Street 1:28 TIMBER TRAIL LN
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2121
Practice Address - Country:US
Practice Address - Phone:631-346-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309907-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse