Provider Demographics
NPI:1013136332
Name:RAIDER, ANDREA M (NP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:M
Last Name:RAIDER
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 1:1001 POTRERO AVE # 6D8
Mailing Address - Street 2:SFGH, OB-GYN
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-8336
Mailing Address - Fax:
Practice Address - Street 1:1001 POTRERO AVE # 6D8
Practice Address - Street 2:SFGH, OB-GYN
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-8336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN483720163WP2201X
CANP7257363LX0001X
CANPF7257363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Not Answered363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
025825OtherSFGH INTERNAL USE ONLY-COMMERCIAL NUMBER