Provider Demographics
NPI:1013440726
Name:CRANDALL, ANDREA (PNP-PC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:KOSARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7856 E 22ND PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9235 CROWN CREST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8880
Practice Address - Country:US
Practice Address - Phone:720-458-6543
Practice Address - Fax:720-458-6544
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0991394363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics