Provider Demographics
NPI:1356392666
Name:ARENDS, ANDREW ALLEN (PA-C)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:ALLEN
Last Name:ARENDS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:ANDY
Other - Middle Name:ALLEN
Other - Last Name:ARENDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:600 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BERESFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57004-1125
Mailing Address - Country:US
Mailing Address - Phone:605-763-5002
Mailing Address - Fax:
Practice Address - Street 1:600 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:BERESFORD
Practice Address - State:SD
Practice Address - Zip Code:57004-1125
Practice Address - Country:US
Practice Address - Phone:605-763-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0458363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS101885Medicare PIN
SDP22275Medicare UPIN