Provider Demographics
NPI:1013137892
Name:ANDRESEN, NANCY BERNADETTE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:BERNADETTE
Last Name:ANDRESEN
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 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-2400
Mailing Address - Fax:215-707-4034
Practice Address - Street 1:1700 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121
Practice Address - Country:US
Practice Address - Phone:215-707-2679
Practice Address - Fax:215-707-1784
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP001927C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN225770LOtherFAMILY MEDICINE