Provider Demographics
NPI:1740416841
Name:AMES, ANDREA SUE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:SUE
Last Name:AMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 INNOVATOR DR UNIT 35106
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-3894
Mailing Address - Country:US
Mailing Address - Phone:707-334-0290
Mailing Address - Fax:
Practice Address - Street 1:4000 INNOVATOR DR UNIT 35106
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3894
Practice Address - Country:US
Practice Address - Phone:707-334-0290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program