Provider Demographics
NPI:1033150024
Name:KASTER, ANDREA LEIGH NELLERMOE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEIGH NELLERMOE
Last Name:KASTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:NELLERMOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2010
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58122-2484
Mailing Address - Country:US
Mailing Address - Phone:701-234-2000
Mailing Address - Fax:
Practice Address - Street 1:801 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-3641
Practice Address - Country:US
Practice Address - Phone:701-234-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43686207Q00000X
ND13010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0114429OtherMEDICA #
ND18314Medicaid
MN504199600Medicaid
MN0114428OtherMEDICA #
MN0114436OtherMEDICA #
MNHP39698OtherHEALTHPARTNERS #
FM71G46KAOtherMNBS #
MN71G47KAOtherMNBS #
MN71G48KAOtherMNBS #
MN137043OtherUCARE #
MN1935876OtherAMERICA'S PPO/ARAZ #
MN23613OtherNDBS #
MNDA9041040454OtherPREFERRED ONE #
MN0114436OtherMEDICA #
MN1935876OtherAMERICA'S PPO/ARAZ #
MNP00128446Medicare ID - Type UnspecifiedRR MEDICARE #
MN504199600Medicaid
MN137043OtherUCARE #
MNH41148Medicare UPIN
MN080012737Medicare ID - Type UnspecifiedMN MEDICARE #