Provider Demographics
NPI:1235242967
Name:GEORGE, ANDREA LYNNE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LYNNE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LYNNE
Other - Last Name:ZEKAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:45 W 46TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4109
Mailing Address - Country:US
Mailing Address - Phone:516-360-3248
Mailing Address - Fax:
Practice Address - Street 1:45 W 46TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4109
Practice Address - Country:US
Practice Address - Phone:516-360-3248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY655666-01163W00000X
WV53655163WP0000X, 363L00000X, 363LF0000X
NYF337467-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3910000473OtherGROUP MEDICAID
WVD050OtherGROUP MEDICARE
WV9367141OtherGROUP MEDICARE
WV3810007944OtherGROUP MEDICAID SMMM
WV9367141OtherGROUP MEDICARE
WV9359501Medicare PIN
WVDE2690OtherRR MEDICARE
WV1066023OtherBRICKSTREET INDIVIDUAL
WV20373549400OtherWORKERS COMP
WVP00334442OtherRR MEDICARE
WV001722103OtherMOUNTAIN STATE BCBS
WV3810004173Medicaid
WVNP16633Medicare PIN
WV611007300OtherFEDERAL WORKER'S COMP