Provider Demographics
NPI:1972348522
Name:PANTEL, ANDREA (RN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:PANTEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:LOHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:324 WESLEY ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1865
Mailing Address - Country:US
Mailing Address - Phone:248-630-6053
Mailing Address - Fax:
Practice Address - Street 1:324 WESLEY ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1865
Practice Address - Country:US
Practice Address - Phone:248-630-6053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704196585163W00000X, 163WP0808X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty