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Individual
ANDREA CLEGG
Active
Individual
ANDREA CLEGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704218011
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10-4773362
—
MI
05
—
10-4773371
—
MI
05
—
10-4773380
—
MI
05
—
10-4773390
—
MI
05
—
10-4773406
—
MI
05
—
11-4941038
—
MI
05
—
11-4941047
—
MI
05
—
11-4941056
—
MI
05
—
11-4941065
—
MI
01
—
11712499
CAQH
—
01
—
5008604240
BCBS
MI
01
—
P00380696
RAILROAD MEDICARE
—
Enumeration date
01/04/2006
Last updated
01/05/2021
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