Provider Demographics
NPI:1679776538
Name:MCKILLIPS, ANDREA MARIE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:MCKILLIPS
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 1:1035 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-1819
Mailing Address - Country:US
Mailing Address - Phone:419-624-0091
Mailing Address - Fax:
Practice Address - Street 1:1035 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-1819
Practice Address - Country:US
Practice Address - Phone:419-624-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 088091164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse