Provider Demographics
NPI:1477371920
Name:ANDREWS, CARLEE RAE
Entity type:Individual
Prefix:
First Name:CARLEE
Middle Name:RAE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6239 SUMMER POND DR APT I
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-4632
Mailing Address - Country:US
Mailing Address - Phone:843-267-8230
Mailing Address - Fax:
Practice Address - Street 1:6239 SUMMER POND DR APT I
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-4632
Practice Address - Country:US
Practice Address - Phone:843-267-8230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110010642363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant