Provider Demographics
NPI:1477538684
Name:URBAN, ANDREA DANN (APRN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DANN
Last Name:URBAN
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 1:2 CHURCH ST S
Mailing Address - Street 2:SUITE 404
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1717
Mailing Address - Country:US
Mailing Address - Phone:203-764-6745
Mailing Address - Fax:203-764-6748
Practice Address - Street 1:2 CHURCH ST S
Practice Address - Street 2:SUITE 404
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1717
Practice Address - Country:US
Practice Address - Phone:203-764-6745
Practice Address - Fax:203-764-6748
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002448363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004244307Medicaid
CT500001281Medicare ID - Type Unspecified
CT004244307Medicaid