Provider Demographics
NPI:1932725074
Name:JOURNEY, ANDREA JEANETTE (BSN,RN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JEANETTE
Last Name:JOURNEY
Suffix:
Gender:F
Credentials:BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10296A STATE ROUTE 125
Mailing Address - Street 2:
Mailing Address - City:WEST PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45663-8910
Mailing Address - Country:US
Mailing Address - Phone:740-935-1109
Mailing Address - Fax:
Practice Address - Street 1:10296A STATE ROUTE 125
Practice Address - Street 2:
Practice Address - City:WEST PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45663-8910
Practice Address - Country:US
Practice Address - Phone:740-935-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH365610163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN.365610OtherDOL