Provider Demographics
NPI:1487155594
Name:ANDRE, WENDA
Entity type:Individual
Prefix:
First Name:WENDA
Middle Name:
Last Name:ANDRE
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 1:96 PLYMOUTH DR APT 2B
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5475
Mailing Address - Country:US
Mailing Address - Phone:617-708-5561
Mailing Address - Fax:
Practice Address - Street 1:96 PLYMOUTH DR APT 2B
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5475
Practice Address - Country:US
Practice Address - Phone:617-708-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker