Provider Demographics
NPI:1821327149
Name:REDMON, ANDREA DIANNE (DNP, NNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DIANNE
Last Name:REDMON
Suffix:
Gender:F
Credentials:DNP, NNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:DIANNE
Other - Last Name:CAUGHREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:645 E MISSOURI AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1351
Mailing Address - Country:US
Mailing Address - Phone:888-513-6044
Mailing Address - Fax:
Practice Address - Street 1:645 E MISSOURI AVE STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1351
Practice Address - Country:US
Practice Address - Phone:888-513-6044
Practice Address - Fax:505-272-8060
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP23442363LN0005X
AZAP5636363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care