| Doctor Name: | MARK ANDREIS |
| NPI Number: | 1114315207 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 180990 |
| Business Practice Address: | 2271 Surrey Ln Canon City, CO - 812122565 |
| Business Phone Number: | 7192760638 |
| Business Fax Number: | |
| Mailing Address: | 2271 Surrey Ln, CANON CITY |
| State: | CO |
| Postal Code: | 812122565 |
| Phone Number: | 7192760638 |
| Fax Number: | |
| NPI Enumeration Date: | 12/26/2014 |
| NPI Last Update Date: | 12/26/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC0400X |
| License Number: | 180990 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Case Management |
| Taxonomy Definition: | |