Provider Demographics
NPI:1326496183
Name:UZUEGBUNEM, ANDREA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:UZUEGBUNEM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:BEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2208 NW 173RD ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-7146
Mailing Address - Country:US
Mailing Address - Phone:269-589-9049
Mailing Address - Fax:
Practice Address - Street 1:46 E 15TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4301
Practice Address - Country:US
Practice Address - Phone:405-844-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2639363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical