Provider Demographics
NPI:1902306509
Name:ANDRE, MIRLYNE (NP)
Entity type:Individual
Prefix:
First Name:MIRLYNE
Middle Name:
Last Name:ANDRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MIRLYNE
Other - Middle Name:
Other - Last Name:ANDRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1587 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3126
Mailing Address - Country:US
Mailing Address - Phone:929-302-1856
Mailing Address - Fax:
Practice Address - Street 1:1587 E 49TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3126
Practice Address - Country:US
Practice Address - Phone:929-302-1856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY744373163W00000X
NYF354158-01363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse