Provider Demographics
NPI:1437722493
Name:ANDRADE, MICAH K (NP)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:K
Last Name:ANDRADE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73-1497A HAO PL
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-8657
Mailing Address - Country:US
Mailing Address - Phone:808-987-3384
Mailing Address - Fax:
Practice Address - Street 1:78-6831 ALII DR
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2495
Practice Address - Country:US
Practice Address - Phone:808-747-8321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3243363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care