Provider Demographics
NPI:1326401761
Name:FAIR, ANDROMEDA (CRNP)
Entity type:Individual
Prefix:
First Name:ANDROMEDA
Middle Name:
Last Name:FAIR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 PEACH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2771
Mailing Address - Country:US
Mailing Address - Phone:814-877-8586
Mailing Address - Fax:
Practice Address - Street 1:3330 PEACH ST STE 106
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2771
Practice Address - Country:US
Practice Address - Phone:814-877-8586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-02
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN642005163W00000X
OHRN.382551163W00000X
PASP016598363LW0102X
PASP027602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health