Provider Demographics
NPI:1790399376
Name:ANDREWS, MIRESHA (CNA/HHA)
Entity Type:Individual
Prefix:
First Name:MIRESHA
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:CNA/HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S OLIVER AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2351
Mailing Address - Country:US
Mailing Address - Phone:316-993-6779
Mailing Address - Fax:
Practice Address - Street 1:2851 S MEAD ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67216-1112
Practice Address - Country:US
Practice Address - Phone:316-993-6779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist