Provider Demographics
NPI:1245217579
Name:WALSH, ANDREA RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:RENEE
Last Name:WALSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:RENEE
Other - Last Name:TIDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1518 MULBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-3433
Mailing Address - Country:US
Mailing Address - Phone:563-262-4111
Mailing Address - Fax:
Practice Address - Street 1:UNITY POINT CLINIC/HEALTH - TRINITY MUSCATINE
Practice Address - Street 2:1518 MULBERRY AVE
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52358
Practice Address - Country:US
Practice Address - Phone:563-262-4111
Practice Address - Fax:563-264-9175
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1273363A00000X
IA01273363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP02110Medicare UPIN
IA17149Medicare PIN