Individual
TIMOTHY ANDRESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
500 CAMPUS DR, HANCOCK, MI 49930-1569
(906) 483-1356
(906) 483-1320
Mailing address
500 CAMPUS DR, HANCOCK, MI 49930-1569
(906) 483-1356
(906) 483-1320
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
036298
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0829560001
MEDICARE DME
MI
01
—
0C16002
MEDICARE GROUP
MI
05
—
101616429
—
MI
01
—
430041684
MEDICARE RAILROAD
MI
01
—
TA036298
BLUE CROSS STATE ID
MI
Enumeration date
04/09/2007
Last updated
12/07/2009
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