Provider Demographics
NPI:1265737530
Name:VON DER VELLEN, ANDREA MARIE (CNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:VON DER VELLEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 GRANTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-4032
Mailing Address - Country:US
Mailing Address - Phone:216-661-3319
Mailing Address - Fax:
Practice Address - Street 1:1299 INDUSTRIAL PKWY N
Practice Address - Street 2:SUITE 110
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-4316
Practice Address - Country:US
Practice Address - Phone:330-225-6468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12039-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily