Provider Demographics
NPI:1013339688
Name:EDWARDS, ANDRE (NP)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 EXPOSITION BLVD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4314
Mailing Address - Country:US
Mailing Address - Phone:916-736-3399
Mailing Address - Fax:916-469-4382
Practice Address - Street 1:1111 EXPOSITION BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4314
Practice Address - Country:US
Practice Address - Phone:916-736-3399
Practice Address - Fax:916-469-4382
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANPF22262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPF22262OtherLICENSE