Provider Demographics
NPI:1982925475
Name:MCGREW, ANDREA NICHOLE (RDN/LD)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:NICHOLE
Last Name:MCGREW
Suffix:
Gender:F
Credentials:RDN/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-2713
Mailing Address - Country:US
Mailing Address - Phone:417-825-8847
Mailing Address - Fax:
Practice Address - Street 1:1217 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-2713
Practice Address - Country:US
Practice Address - Phone:417-825-8847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010001121133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO133V00000XMedicaid