Provider Demographics
NPI:1588022560
Name:WARBURTON, ANDREA (PAC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WARBURTON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 WIGWAM PKWY
Mailing Address - Street 2:STE 102
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7115
Mailing Address - Country:US
Mailing Address - Phone:702-515-1374
Mailing Address - Fax:
Practice Address - Street 1:2510 WIGWAM PKWY STE 102
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7115
Practice Address - Country:US
Practice Address - Phone:702-283-2552
Practice Address - Fax:702-331-3098
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV363A00000X
NVPA1712363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant