Provider Demographics
NPI:1245469873
Name:SICKINGER, ANDREA HUTCHINS (PA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:HUTCHINS
Last Name:SICKINGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 BIRNIE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1108
Mailing Address - Country:US
Mailing Address - Phone:413-733-3470
Mailing Address - Fax:
Practice Address - Street 1:354 BIRNIE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1108
Practice Address - Country:US
Practice Address - Phone:413-733-3470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2417-023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1245469873OtherBLUE CROSS BLUE SHIELD
WI1245469873Medicaid
WI1245469873Medicaid