Provider Demographics
NPI:1891782363
Name:MCANDREW, ELLEN P (CNM)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:P
Last Name:MCANDREW
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:F
Other - Last Name:PIQUETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:125 MASCOMA ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2647
Mailing Address - Country:US
Mailing Address - Phone:603-448-3121
Mailing Address - Fax:603-448-7462
Practice Address - Street 1:57 MASCOMA ST
Practice Address - Street 2:SUITE G1-1
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2642
Practice Address - Country:US
Practice Address - Phone:603-442-5677
Practice Address - Fax:603-448-7462
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0196842301367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1002476Medicaid
VT00005558OtherBC BS VT
NH22470YOtherANTHEM UPIN
NH30343027Medicaid
NHRE8195Medicare ID - Type Unspecified
NH30343027Medicaid