Provider Demographics
NPI:1063722106
Name:JAMES, ANDREA (LPN)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:JAMES
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 1:900 MERCHANTS CONCOURSE STE 308
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5114
Mailing Address - Country:US
Mailing Address - Phone:516-565-6322
Mailing Address - Fax:516-565-6325
Practice Address - Street 1:900 MERCHANTS CONCOURSE STE 308
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5114
Practice Address - Country:US
Practice Address - Phone:516-565-6322
Practice Address - Fax:516-565-6325
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302065-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1750493706Medicaid