Provider Demographics
NPI:1003179839
Name:BEQUEST, ANDREA L (PA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:BEQUEST
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-0350
Mailing Address - Fax:414-805-6851
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-955-0350
Practice Address - Fax:414-805-6851
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2023-03-15
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Provider Licenses
StateLicense IDTaxonomies
WI2952-23363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1003179839Medicaid