Provider Demographics
NPI:1245456821
Name:EDEN, ANDREA OPAL (DO)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:OPAL
Last Name:EDEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1226
Mailing Address - Country:US
Mailing Address - Phone:888-878-6881
Mailing Address - Fax:620-728-0823
Practice Address - Street 1:1625 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1226
Practice Address - Country:US
Practice Address - Phone:888-878-6881
Practice Address - Fax:620-728-0823
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6617207Q00000X
MO2010001130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine