Provider Demographics
NPI:1205849197
Name:INZANA, ANDREA LEE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LEE
Last Name:INZANA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:761 JOHNSONBURG RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3483
Mailing Address - Country:US
Mailing Address - Phone:814-834-1686
Mailing Address - Fax:814-834-6279
Practice Address - Street 1:761 JOHNSONBURG RD
Practice Address - Street 2:SUITE 310
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3483
Practice Address - Country:US
Practice Address - Phone:814-834-1686
Practice Address - Fax:814-834-6279
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002751L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S74450Medicare UPIN
PA024576Medicare ID - Type Unspecified