Provider Demographics
NPI:1356624027
Name:DAMERON, ANDREA (APRN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:DAMERON
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 1:627 NORWICH SALEM TPKE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CT
Mailing Address - Zip Code:06370
Mailing Address - Country:US
Mailing Address - Phone:860-222-0949
Mailing Address - Fax:888-326-5828
Practice Address - Street 1:627 NORWICH SALEM TPKE UNIT 2
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CT
Practice Address - Zip Code:06370
Practice Address - Country:US
Practice Address - Phone:860-222-0949
Practice Address - Fax:888-326-5828
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008035033Medicaid
CTD400059493Medicare PIN