Provider Demographics
NPI:1881809085
Name:PAGUIRIGAN, ANDREA GREENE (MPAS PAC)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:GREENE
Last Name:PAGUIRIGAN
Suffix:
Gender:F
Credentials:MPAS PAC
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:GREENE
Other - Last Name:SANTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPAS PAC
Mailing Address - Street 1:11925 LITHOPOLIS RD NW
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110
Mailing Address - Country:US
Mailing Address - Phone:614-837-6363
Mailing Address - Fax:614-837-0425
Practice Address - Street 1:11925 LITHOPOLIS RD NW
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110
Practice Address - Country:US
Practice Address - Phone:614-837-6363
Practice Address - Fax:614-837-0425
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001393RX363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0075070Medicaid
OHPA28722Medicare PIN