Provider Demographics
NPI:1770748089
Name:PARKER, ANDREA E (RN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:PARKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25059 STONYCROFT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2717
Mailing Address - Country:US
Mailing Address - Phone:313-414-5998
Mailing Address - Fax:248-212-0193
Practice Address - Street 1:25059 STONYCROFT DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-2717
Practice Address - Country:US
Practice Address - Phone:313-414-5998
Practice Address - Fax:248-212-0193
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704100545163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator