Provider Demographics
NPI:1083013056
Name:METZLER, ANDREA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:METZLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 E HOLDEN LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5042
Mailing Address - Country:US
Mailing Address - Phone:773-454-1600
Mailing Address - Fax:
Practice Address - Street 1:7979 W RIFLEMAN ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-855-2410
Practice Address - Fax:208-855-0157
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001711A363AS0400X
IDPA-1703207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery