Provider Demographics
NPI:1154395721
Name:DEMERS, ANDREA NANCY (CNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:NANCY
Last Name:DEMERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 RESERVOIR AVE STE 6A
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4450
Mailing Address - Country:US
Mailing Address - Phone:401-944-6889
Mailing Address - Fax:401-944-6726
Practice Address - Street 1:725 RESERVOIR AVE STE 6A
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4450
Practice Address - Country:US
Practice Address - Phone:401-829-4446
Practice Address - Fax:401-829-4434
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01313363LA2100X, 363LA2100X
RINPP37469363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110015668AMedicaid
MAP22859Medicare UPIN
MANP301801Medicare PIN