Basic Information
| Provider Information | |||||||||
| NPI: | 1083067631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDREWS | ||||||||
| FirstName: | KINDAL | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HARTLEY | ||||||||
| OtherFirstName: | KINDAL | ||||||||
| OtherMiddleName: | LEE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 925 IRONWOOD DR | ||||||||
| Address2: | SUITE 2102 | ||||||||
| City: | MINDEN | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894235178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754457745 | ||||||||
| FaxNumber: | 7757820073 | ||||||||
| Practice Location | |||||||||
| Address1: | 925 IRONWOOD DR | ||||||||
| Address2: | SUITE 2102 | ||||||||
| City: | MINDEN | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894235178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754457745 | ||||||||
| FaxNumber: | 7757820073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2016 | ||||||||
| LastUpdateDate: | 07/19/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN0002235 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.