Provider Demographics
NPI:1871190959
Name:BESTER, ANDREA AUTOMILUS
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:AUTOMILUS
Last Name:BESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24390 LAKE SHORE BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1277
Mailing Address - Country:US
Mailing Address - Phone:216-952-6615
Mailing Address - Fax:
Practice Address - Street 1:24390 LAKE SHORE BLVD APT C
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1277
Practice Address - Country:US
Practice Address - Phone:216-952-6615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2023-03-22
Deactivation Date:2020-10-20
Deactivation Code:
Reactivation Date:2023-03-07
Provider Licenses
StateLicense IDTaxonomies
OHRP931557343900000X, 373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty