Provider Demographics
NPI:1982434114
Name:MCCOURT, ANDREA J
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:MCCOURT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:OH
Mailing Address - Zip Code:45326
Mailing Address - Country:US
Mailing Address - Phone:937-541-8552
Mailing Address - Fax:
Practice Address - Street 1:230 KIENLE DR
Practice Address - Street 2:APT 2A
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356
Practice Address - Country:US
Practice Address - Phone:937-381-7908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant