Provider Demographics
NPI:1891325627
Name:LIGE, ANDREA (NP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LIGE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 DOLPHIN
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1009
Mailing Address - Country:US
Mailing Address - Phone:313-492-7991
Mailing Address - Fax:
Practice Address - Street 1:7320 DOLPHIN
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1009
Practice Address - Country:US
Practice Address - Phone:313-492-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704297059363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily