Provider Demographics
NPI:1790342145
Name:ALAM, ANDREA CRYSTAN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:CRYSTAN
Last Name:ALAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 SULLIVAN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-4268
Mailing Address - Country:US
Mailing Address - Phone:949-378-3320
Mailing Address - Fax:
Practice Address - Street 1:1329 SULLIVAN
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4268
Practice Address - Country:US
Practice Address - Phone:949-378-3320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008152363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care