Provider Demographics
NPI:1811470479
Name:BARRETT, ANDREA C
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:C
Last Name:BARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:C
Other - Last Name:MOUDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5029 BLANTON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-6605
Mailing Address - Country:US
Mailing Address - Phone:702-609-4448
Mailing Address - Fax:
Practice Address - Street 1:5029 BLANTON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6605
Practice Address - Country:US
Practice Address - Phone:702-609-4448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide