Provider Demographics
NPI:1245734144
Name:ANDRADE MEDICAL SERVICES
Entity Type:Organization
Organization Name:ANDRADE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:405-509-2918
Mailing Address - Street 1:1601 S STATE ST STE 425
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3626
Mailing Address - Country:US
Mailing Address - Phone:405-509-2918
Mailing Address - Fax:405-815-3425
Practice Address - Street 1:1601 S STATE ST STE 425
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3626
Practice Address - Country:US
Practice Address - Phone:405-509-2918
Practice Address - Fax:405-815-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty