Provider Demographics
NPI:1821556705
Name:ANDREWS, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 CASS ELIZABETH RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-4206
Mailing Address - Country:US
Mailing Address - Phone:313-510-8563
Mailing Address - Fax:313-692-6117
Practice Address - Street 1:4125 CASS ELIZABETH RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-4206
Practice Address - Country:US
Practice Address - Phone:313-510-8563
Practice Address - Fax:313-692-6117
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-09
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty