Provider Demographics
NPI:1922300318
Name:ROBERTS, ANDREA ELIZABETH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 42ND ST
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-1109
Mailing Address - Country:US
Mailing Address - Phone:631-672-1302
Mailing Address - Fax:
Practice Address - Street 1:555 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-1115
Practice Address - Country:US
Practice Address - Phone:631-842-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279749-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse