Provider Demographics
NPI:1265468375
Name:ANDERSON, ANDREA R (FNP PHD)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:R
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP PHD
Other - Prefix:MS
Other - First Name:ROSWITHA
Other - Middle Name:ANDREA
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP PHD
Mailing Address - Street 1:1001 SHORELINE DR # 105
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5969
Mailing Address - Country:US
Mailing Address - Phone:510-769-1079
Mailing Address - Fax:
Practice Address - Street 1:384 EMBARCADERO W
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3735
Practice Address - Country:US
Practice Address - Phone:510-465-9565
Practice Address - Fax:510-465-3840
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419470363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily