Provider Demographics
NPI:1609336783
Name:ENTZ, ANDA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:ANDA
Middle Name:MARIE
Last Name:ENTZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANDA
Other - Middle Name:MARIE
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:971 90TH
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:KS
Mailing Address - Zip Code:66866-9459
Mailing Address - Country:US
Mailing Address - Phone:167-723-3306
Mailing Address - Fax:
Practice Address - Street 1:1776 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-9301
Practice Address - Country:US
Practice Address - Phone:620-718-8118
Practice Address - Fax:620-241-1351
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78537363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
F12180429OtherAANP FNP NUMBER