Provider Demographics
NPI:1518112168
Name:ANDRYSIAK, KATHRYN (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:ANDRYSIAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 S LEWIS
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6234
Mailing Address - Country:US
Mailing Address - Phone:602-506-2703
Mailing Address - Fax:602-506-2548
Practice Address - Street 1:1810 S LEWIS
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6234
Practice Address - Country:US
Practice Address - Phone:602-506-2703
Practice Address - Fax:602-506-2548
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily