Provider Demographics
NPI:1386384220
Name:VANHOOSER, ANDREA DAWN (RN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DAWN
Last Name:VANHOOSER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 COPPERAS RD
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026
Mailing Address - Country:US
Mailing Address - Phone:573-286-2147
Mailing Address - Fax:
Practice Address - Street 1:1002 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6901
Practice Address - Country:US
Practice Address - Phone:573-636-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009004829163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse