Provider Demographics
NPI:1669935680
Name:SAUER, ANDREA MARIE
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:MARIE
Last Name:SAUER
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:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-0463
Mailing Address - Country:US
Mailing Address - Phone:574-335-9582
Mailing Address - Fax:
Practice Address - Street 1:310 N MICHIGAN ST STE 203
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1774
Practice Address - Country:US
Practice Address - Phone:574-936-6875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi