Provider Demographics
NPI:1336564038
Name:ODVARKO, ANDREA (ARNP, DNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ODVARKO
Suffix:
Gender:F
Credentials:ARNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746870
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6870
Mailing Address - Country:US
Mailing Address - Phone:469-727-6675
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:2217 ROCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52802-2809
Practice Address - Country:US
Practice Address - Phone:563-900-8465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA106690363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine