Provider Demographics
NPI:1811627706
Name:BESS, ANDRENIQUE
Entity type:Individual
Prefix:
First Name:ANDRENIQUE
Middle Name:
Last Name:BESS
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 1:34971 AQUARIUS DR APT E210
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5633
Mailing Address - Country:US
Mailing Address - Phone:313-221-7657
Mailing Address - Fax:
Practice Address - Street 1:34971 AQUARIUS DR APT E210
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5633
Practice Address - Country:US
Practice Address - Phone:313-221-7657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501014779225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB200067585644Medicaid