Provider Demographics
NPI:1720263189
Name:KRAUSE, ANDREA (APNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:BAIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:109 HUMMINGBIRD CT
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-6913
Practice Address - Country:US
Practice Address - Phone:803-732-7453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3329-033363L00000X
SC4152363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1960Medicaid
WI36056100Medicaid
004546515Medicare PIN
004704130Medicare PIN
004554475Medicare PIN
004540245Medicare PIN