Healthcare Provider Details

I. General information

NPI: 1063696318
Provider Name (Legal Business Name): ANDREA CORINNE TRADER-MCKENNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA CORINNE TRADER MD

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 MAIN ST
WINTERS CA
95694-1722
US

IV. Provider business mailing address

PO BOX 842
WINTERS CA
95694-0842
US

V. Phone/Fax

Practice location:
  • Phone: 530-795-4377
  • Fax:
Mailing address:
  • Phone: 707-410-8519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberG87561
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: