Provider Demographics
NPI:1639064173
Name:WITHERS, ANDREW
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:WITHERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S HURON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5453
Mailing Address - Country:US
Mailing Address - Phone:734-344-9408
Mailing Address - Fax:
Practice Address - Street 1:109 S HURON ST APT 3
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5453
Practice Address - Country:US
Practice Address - Phone:734-344-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
No251J00000XAgenciesNursing Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other