Provider Demographics
NPI:1891771275
Name:ANDREWS, CONNIE (CRNP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4682 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3124
Mailing Address - Country:US
Mailing Address - Phone:251-343-5004
Mailing Address - Fax:251-343-8383
Practice Address - Street 1:4682 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3124
Practice Address - Country:US
Practice Address - Phone:251-343-5004
Practice Address - Fax:251-343-8383
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-042918363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000051032Medicaid
AL000051032Medicaid
ALP39682Medicare UPIN