# ANDREA CLEGG

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1285612861
- **Gender:** F
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 4704218011 | MI | Yes |

## Other

- **Enumeration date:** 01/04/2006
- **Last updated:** 01/05/2021

## 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 | — |