Provider Demographics
NPI:1114176443
Name:GOLDBAUM, ANDREA SEFKIN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:SEFKIN
Last Name:GOLDBAUM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:SEFKIN
Other - Last Name:BIRNBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3806 EDMUND BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-3610
Mailing Address - Country:US
Mailing Address - Phone:612-728-5844
Mailing Address - Fax:
Practice Address - Street 1:2810 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4708
Practice Address - Country:US
Practice Address - Phone:612-545-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-183239-0363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily