Provider Demographics
NPI:1205546959
Name:MALEY, ANDREA MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MARIE
Last Name:MALEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 N STATE HIGHWAY 3
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-7117
Mailing Address - Country:US
Mailing Address - Phone:812-772-4380
Mailing Address - Fax:
Practice Address - Street 1:411 W TIPTON ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2363
Practice Address - Country:US
Practice Address - Phone:812-523-7870
Practice Address - Fax:812-523-4752
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013606A363LF0000X
IN28239341A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner