Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 4704299513 | MI |
NPI | 1023602992 |
---|---|
Provider Name | Ms. Andrea Jessica Covrea |
First Address | Port Huron, MI 48060-8127 |
Second Address | Port Huron, MI 48060-8127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2021 |
Last Update Date | 24/01/2022 |