Provider Demographics
NPI:1568614022
Name:WILLS, ANDEAN ANDREA (FNP BC)
Entity Type:Individual
Prefix:MRS
First Name:ANDEAN
Middle Name:ANDREA
Last Name:WILLS
Suffix:
Gender:F
Credentials:FNP BC
Other - Prefix:
Other - First Name:ANDEAN
Other - Middle Name:ANDREA
Other - Last Name:WILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 E AVON DR
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2023
Mailing Address - Country:US
Mailing Address - Phone:516-996-3323
Mailing Address - Fax:
Practice Address - Street 1:3 ROSEWOOD ST
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4705
Practice Address - Country:US
Practice Address - Phone:516-996-3323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY577868-1163W00000X
NYF343071-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse