Provider Demographics
NPI:1902897630
Name:ANDREWS, SUSAN M (APRNBC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:APRNBC
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:WOOLDRIDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRNBC
Mailing Address - Street 1:910 MADISON AVE STE 922
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-0001
Mailing Address - Country:US
Mailing Address - Phone:901-448-5630
Mailing Address - Fax:
Practice Address - Street 1:910 MADISON AVE STE 922
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-0001
Practice Address - Country:US
Practice Address - Phone:901-448-5630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005936363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3632485Medicaid
TNP00175298OtherRAILROAD MEDICARE
TN3632485Medicaid
TNQ16989Medicare UPIN