Provider Demographics
NPI:1962719229
Name:TERRELL, ANDREA R (PHD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:TERRELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-4352
Mailing Address - Country:US
Mailing Address - Phone:317-243-3894
Mailing Address - Fax:
Practice Address - Street 1:2265 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-4352
Practice Address - Country:US
Practice Address - Phone:317-243-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician