Provider Demographics
NPI:1750099636
Name:WUCHERPFENNIG, ANDREA JOY (RN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JOY
Last Name:WUCHERPFENNIG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CENTRAL ST APT 15
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2832
Mailing Address - Country:US
Mailing Address - Phone:303-870-2586
Mailing Address - Fax:
Practice Address - Street 1:19 CENTRAL ST APT 15
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-2832
Practice Address - Country:US
Practice Address - Phone:303-870-2586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2372337163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics