Basic Information
| Provider Information | |||||||||
| NPI: | 1386714988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COX | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 86 SYRACUSE ST | ||||||||
| Address2: | |||||||||
| City: | BALDWINSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130272932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153034310 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 25 CHAUCER CIR | ||||||||
| Address2: | |||||||||
| City: | BALDWINSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130278254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3156351517 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 189217-1 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.