Provider Demographics
NPI:1386029163
Name:D'ANDREA, JENNIFER DAWSON (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWSON
Last Name:D'ANDREA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2779 W HORIZON RIDGE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4186
Mailing Address - Country:US
Mailing Address - Phone:702-990-2290
Mailing Address - Fax:
Practice Address - Street 1:2779 W HORIZON RIDGE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4186
Practice Address - Country:US
Practice Address - Phone:702-990-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60591634363L00000X, 363LP2300X
NV816422363LF0000X
WAF0715892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8966792OtherMEDICARE