Provider Demographics
NPI:1891294682
Name:COLE, ANDREW (CRNP-PMH)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 LIBERTY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6545
Mailing Address - Country:US
Mailing Address - Phone:443-920-5333
Mailing Address - Fax:443-920-5334
Practice Address - Street 1:1643 LIBERTY RD STE 105
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6545
Practice Address - Country:US
Practice Address - Phone:443-920-5333
Practice Address - Fax:443-920-5334
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR208452363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health