Provider Demographics
NPI:1992336507
Name:ANDREAS, JESSE CHRISTOPHER (LAC)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:CHRISTOPHER
Last Name:ANDREAS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 LAKE BRANDT PL APT H
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 LENDEW ST STE 11
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7012
Practice Address - Country:US
Practice Address - Phone:336-510-2029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC845171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist