Healthcare Provider Details

I. General information

NPI: 1780808931
Provider Name (Legal Business Name): ANDREA R WARD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BLUE RIDGE RD SUITE 403
RALEIGH NC
27607-6478
US

IV. Provider business mailing address

2800 BLUE RIDGE RD SUITE 403
RALEIGH NC
27607-6478
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-7110
  • Fax: 919-784-7111
Mailing address:
  • Phone: 919-784-7110
  • Fax: 919-784-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number890
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2024045093
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0010-01988
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: