Healthcare Provider Details

I. General information

NPI: 1538893243
Provider Name (Legal Business Name): ANDRA IOANA MINA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 APPLEGATE RD
MADISON WI
53713-3184
US

IV. Provider business mailing address

17 MANCHESTER CT
MADISON WI
53719-1566
US

V. Phone/Fax

Practice location:
  • Phone: 608-405-8877
  • Fax:
Mailing address:
  • Phone: 608-707-7859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209025422
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: