Provider Demographics
NPI:1073092383
Name:LINGENFELTER, ANDREA L (FNP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:L
Last Name:LINGENFELTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 EAST BROADWAY, STE. 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201
Mailing Address - Country:US
Mailing Address - Phone:573-443-2355
Mailing Address - Fax:573-874-3025
Practice Address - Street 1:1605 EAST BROADWAY, STE. 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-443-2355
Practice Address - Fax:573-874-3025
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009039680163WC0200X
MO2018031081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Single Specialty