Provider Demographics
NPI:1801883525
Name:BIEGANSKI, ANDREA J (PA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:BIEGANSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2001 S SHIELDS ST BLDG E
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1827
Mailing Address - Country:US
Mailing Address - Phone:970-493-5334
Mailing Address - Fax:970-493-3727
Practice Address - Street 1:2001 S SHIELDS ST BLDG E
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1827
Practice Address - Country:US
Practice Address - Phone:970-493-5334
Practice Address - Fax:970-493-3727
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1001363AS0400X
COPA.0002234363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE274925Medicare PIN
NEP46960Medicare UPIN