Provider Demographics
NPI:1902270697
Name:DOERER, ANDREA (RN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:DOERER
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 1:205 STILLBROOK ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-6505
Mailing Address - Country:US
Mailing Address - Phone:314-913-3117
Mailing Address - Fax:
Practice Address - Street 1:205 STILLBROOK ESTATES DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-6505
Practice Address - Country:US
Practice Address - Phone:314-913-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010005889163W00000X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163W00000XNursing Service ProvidersRegistered Nurse