Provider Demographics
NPI:1023615895
Name:GROW, ANDREA LYNN
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LYNN
Last Name:GROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 FLATFOOT RD
Mailing Address - Street 2:
Mailing Address - City:CABLE
Mailing Address - State:OH
Mailing Address - Zip Code:43009-9741
Mailing Address - Country:US
Mailing Address - Phone:937-418-7164
Mailing Address - Fax:
Practice Address - Street 1:4525 FLATFOOT RD
Practice Address - Street 2:
Practice Address - City:CABLE
Practice Address - State:OH
Practice Address - Zip Code:43009-9741
Practice Address - Country:US
Practice Address - Phone:937-418-7164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No251E00000XAgenciesHome Health