Provider Demographics
NPI:1578621058
Name:OKAGAWA, ANDREA Z (CRNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:Z
Last Name:OKAGAWA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 CLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2804
Mailing Address - Country:US
Mailing Address - Phone:215-572-8137
Mailing Address - Fax:215-951-1565
Practice Address - Street 1:1900 W OLNEY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-1108
Practice Address - Country:US
Practice Address - Phone:215-951-1565
Practice Address - Fax:215-951-1566
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP000274B363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care