Provider Demographics
NPI:1801386768
Name:AGUILAR CORRALES, ANDREA MELISSA (MS)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MELISSA
Last Name:AGUILAR CORRALES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 LANSING AVE STE 257
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2193
Mailing Address - Country:US
Mailing Address - Phone:517-788-4292
Mailing Address - Fax:
Practice Address - Street 1:1715 LANSING AVE STE 257
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2193
Practice Address - Country:US
Practice Address - Phone:517-788-4292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No133N00000XDietary & Nutritional Service ProvidersNutritionist