Provider Demographics
NPI:1821048372
Name:ANDEL, WILLIAM A (ANP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:ANDEL
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1011 BOWLES AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2387
Mailing Address - Country:US
Mailing Address - Phone:636-680-5400
Mailing Address - Fax:
Practice Address - Street 1:1011 BOWLES AVE STE 400
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2387
Practice Address - Country:US
Practice Address - Phone:636-680-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO139341363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1821048372Medicaid
MOP48679Medicare UPIN
MOE26000001Medicare Oscar/Certification