Provider Demographics
NPI:1619405602
Name:JASDANWALA, ANDREA CONSTANCE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CONSTANCE
Last Name:JASDANWALA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:CONSTANCE
Other - Last Name:BINKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1112 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-2408
Mailing Address - Country:US
Mailing Address - Phone:573-739-9806
Mailing Address - Fax:
Practice Address - Street 1:1112 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560
Practice Address - Country:US
Practice Address - Phone:573-739-9806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016035602363LF0000X
MOF09161103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily