Provider Demographics
NPI:1336230630
Name:BARTELS, ANDREA J (APRN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:BARTELS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 MONTAUK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4730
Mailing Address - Country:US
Mailing Address - Phone:860-443-1891
Mailing Address - Fax:860-443-2980
Practice Address - Street 1:350 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4730
Practice Address - Country:US
Practice Address - Phone:860-443-1891
Practice Address - Fax:860-443-2980
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004266038Medicaid
CT003504OtherLICENSE
CT003504OtherLICENSE
CTQ73149Medicare UPIN