Provider Demographics
NPI:1629258173
Name:STAFFORD, ANDREA CHRISTINE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CHRISTINE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:CHRISTINE
Other - Last Name:HARLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8040 CLEARVISTA PKWY
Practice Address - Street 2:STE 460
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5630
Practice Address - Country:US
Practice Address - Phone:317-621-2660
Practice Address - Fax:317-621-1535
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006135A363L00000X, 363LP0200X
GARN185930363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201350080Medicaid
INP01678745OtherMEDICARE RR
INP01678745OtherMEDICARE RR