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NPI Code Detail

MEDICARE: MS. BRIDGET CORNELL ANDREW PA,MPH

MEDICARE: MS. BRIDGET CORNELL ANDREW PA,MPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA2009-043NM
2363AM0700XMedical Physician Assistant2822CO
3363AM0700XMedical Physician Assistant566MT
4363AM0700XMedical Physician Assistant005692-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649279266
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BRIDGET CORNELL ANDREW PA,MPH
Provider Business Mailing Address
First Line : 1035 ALTO ST
Second Line : LA FAMILIA MEDICAL CENTER
City : SANTA FE
State : NM
Zip : 87501-2406
Country : US
Telephone Number : 505-982-4425
Fax Number : 505-982-6280
Provider Business Practice Location Address
First Line : 1035 ALTO ST
Second Line : LA FAMILIA MEDICAL CENTER
City : SANTA FE
State : NM
Zip : 87501-2406
Country : US
Telephone Number : 505-982-4425
Fax Number : 505-982-6280
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2005
Last Update Date : 06/17/2013

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