Provider Demographics
NPI:1750690699
Name:FENN, ANDREA KATHLEEN (RN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:KATHLEEN
Last Name:FENN
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 1:1004 COUNTY ROAD 452
Mailing Address - Street 2:
Mailing Address - City:SWEENY
Mailing Address - State:TX
Mailing Address - Zip Code:77480-4076
Mailing Address - Country:US
Mailing Address - Phone:979-345-3313
Mailing Address - Fax:979-345-3313
Practice Address - Street 1:1004 COUNTY ROAD 452
Practice Address - Street 2:
Practice Address - City:SWEENY
Practice Address - State:TX
Practice Address - Zip Code:77480-4076
Practice Address - Country:US
Practice Address - Phone:979-345-3313
Practice Address - Fax:979-345-3313
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX560968163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical