Provider Demographics
NPI:1134432966
Name:EUBANK, ANDREA MICHELLE (APRN, LAC)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MICHELLE
Last Name:EUBANK
Suffix:
Gender:F
Credentials:APRN, LAC
Other - Prefix:MRS
Other - First Name:ANDI
Other - Middle Name:MICHELLE
Other - Last Name:EUBANK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, LAC
Mailing Address - Street 1:5598 GLENWAY AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-3452
Mailing Address - Country:US
Mailing Address - Phone:513-620-7185
Mailing Address - Fax:
Practice Address - Street 1:5598 GLENWAY AVE STE 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3452
Practice Address - Country:US
Practice Address - Phone:513-620-7185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.451380163W00000X
OH65.000370171100000X
FLAP 2860171100000X
OHAPRN.CNP.0030356363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No171100000XOther Service ProvidersAcupuncturist