Provider Demographics
NPI:1003462631
Name:SMITH, ANDREA N (RN)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44-3703 KUKUIPAPA RD
Mailing Address - Street 2:
Mailing Address - City:PAAUILO
Mailing Address - State:HI
Mailing Address - Zip Code:96776-0523
Mailing Address - Country:US
Mailing Address - Phone:808-937-8088
Mailing Address - Fax:
Practice Address - Street 1:44-3703 KUKUIPAPA RD
Practice Address - Street 2:
Practice Address - City:PAAUILO
Practice Address - State:HI
Practice Address - Zip Code:96776
Practice Address - Country:US
Practice Address - Phone:808-937-8088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN46247163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool