Provider Demographics
NPI:1700511557
Name:MARCOTTE, ANDREA LYNN
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:MARCOTTE
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 1:4100 ROSEDALE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3745
Mailing Address - Country:US
Mailing Address - Phone:513-435-5651
Mailing Address - Fax:
Practice Address - Street 1:4100 ROSEDALE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3745
Practice Address - Country:US
Practice Address - Phone:513-435-5651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker