Provider Demographics
NPI:1922710680
Name:HORSE WITH THE HORN, ANDREA M (RN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:HORSE WITH THE HORN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:LORUSSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 MALDEN ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6117
Mailing Address - Country:US
Mailing Address - Phone:781-985-3370
Mailing Address - Fax:
Practice Address - Street 1:41 MALDEN ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6117
Practice Address - Country:US
Practice Address - Phone:781-985-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2362525163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse