Basic Information
| Provider Information | |||||||||
| NPI: | 1689014912 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINNAN | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MULLEN | ||||||||
| OtherFirstName: | ANDREA | ||||||||
| OtherMiddleName: | JANE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7261 MERCY RD | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681242311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027334433 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4220 L ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681071048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027334433 | ||||||||
| FaxNumber: | 4027331220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 207V00000X | 7071 | NE | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 30134 | NE | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.