Provider Demographics
NPI:1982189213
Name:ANDREWS, AYA (NP)
Entity Type:Individual
Prefix:
First Name:AYA
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9850 W ST LUKES DR STE 180
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7912
Practice Address - Country:US
Practice Address - Phone:208-322-1680
Practice Address - Fax:208-461-8194
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2022-06-28
Deactivation Date:2022-04-12
Deactivation Code:
Reactivation Date:2022-05-06
Provider Licenses
StateLicense IDTaxonomies
ID71763363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner