Healthcare Provider Details

I. General information

NPI: 1104720358
Provider Name (Legal Business Name): ANDREA M PAPA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4480 UTICA RIDGE RD STE 2260
BETTENDORF IA
52722-1656
US

IV. Provider business mailing address

1823 SUSSEX CT
BETTENDORF IA
52722-3156
US

V. Phone/Fax

Practice location:
  • Phone: 563-742-5850
  • Fax:
Mailing address:
  • Phone: 802-310-5254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number153125
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: