Provider Demographics
NPI:1134496490
Name:ARTHUR, ANDREA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:ARTHUR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31739 RIVERSIDE DR STE A1
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-7818
Mailing Address - Country:US
Mailing Address - Phone:951-245-0505
Mailing Address - Fax:
Practice Address - Street 1:31739 RIVERSIDE DR STE A1
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-7818
Practice Address - Country:US
Practice Address - Phone:951-245-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP20925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52985Medicare UPIN