Provider Demographics
NPI:1912558651
Name:ANDAHAZY, CHIARA TERESA KRISTINA COLL (PA-C)
Entity Type:Individual
Prefix:
First Name:CHIARA
Middle Name:TERESA KRISTINA COLL
Last Name:ANDAHAZY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 VALLEY CMNS
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-6102
Mailing Address - Country:US
Mailing Address - Phone:715-410-9596
Mailing Address - Fax:
Practice Address - Street 1:720 WASHINGTON AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2924
Practice Address - Country:US
Practice Address - Phone:612-884-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI490423363A00000X
MN13090363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant