Provider Demographics
NPI:1962641985
Name:MENA, ANDREA PAMELA
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:PAMELA
Last Name:MENA
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 1:14712 KNORPP RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-9378
Mailing Address - Country:US
Mailing Address - Phone:631-495-8741
Mailing Address - Fax:
Practice Address - Street 1:18804 W 160TH TER
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-9636
Practice Address - Country:US
Practice Address - Phone:913-768-0729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-14
Last Update Date:2009-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOU112133007171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator