Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 3009648 | KY |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 71005526A | IN |
NPI | 1033440029 |
---|---|
Provider Name | Mary Charlene Mcandrews |
First Address | Jeffersonville, IN 47130-3554 |
Second Address | Jeffersonville, IN 47130-3554 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2010 |
Last Update Date | 05/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201306820 | (05) | IN |
50095002 | PASSPORT PROVIDER NUMBER (01) | |
P01547739 | MEDICARE RAILROAD (01) | IN |