Provider Demographics
NPI:1811706450
Name:PEREZ, ANDREA ELIZABETH (LPN)
Entity type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 ELLEN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-6641
Mailing Address - Country:US
Mailing Address - Phone:631-875-1701
Mailing Address - Fax:
Practice Address - Street 1:32 ELLEN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-6641
Practice Address - Country:US
Practice Address - Phone:631-875-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY351523164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse