Provider Demographics
NPI:1013755214
Name:MCCOLLUM, ANDREA CRYSTAL (RD, LDN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CRYSTAL
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 MAPLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-7300
Mailing Address - Country:US
Mailing Address - Phone:484-707-2286
Mailing Address - Fax:
Practice Address - Street 1:244 MAPLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-7300
Practice Address - Country:US
Practice Address - Phone:484-707-2286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered