Basic Information
| Provider Information | |||||||||
| NPI: | 1245456821 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDEN | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | OPAL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1625 E 30TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUTCHINSON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675021226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888786881 | ||||||||
| FaxNumber: | 6207280823 | ||||||||
| Practice Location | |||||||||
| Address1: | 1625 E 30TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUTCHINSON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675021226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888786881 | ||||||||
| FaxNumber: | 6207280823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 10/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 6617 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2010001130 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.