Provider Demographics
NPI:1245664218
Name:STAILEY, ANDREA (FNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:STAILEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8767 WILSHIRE BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2714
Mailing Address - Country:US
Mailing Address - Phone:310-423-4938
Mailing Address - Fax:
Practice Address - Street 1:8635 W 3RD ST STE 295
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6166
Practice Address - Country:US
Practice Address - Phone:310-385-6064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily