Provider Demographics
NPI:1629515085
Name:WAKIN, ANDREW (APRN - FNP)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:WAKIN
Suffix:
Gender:M
Credentials:APRN - FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S 42ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2715
Mailing Address - Country:US
Mailing Address - Phone:402-401-4012
Mailing Address - Fax:
Practice Address - Street 1:11704 W CENTER RD
Practice Address - Street 2:SUITE 103 A
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4375
Practice Address - Country:US
Practice Address - Phone:402-334-0177
Practice Address - Fax:402-281-4991
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily