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General NPI Number Information
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NPI Number | 1740267855
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Entity Type | Individual
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Provider Name | ANDREA NEDERVELD MD
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Gender | Female
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 11/23/2007
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Provider Practice Location Address
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Address Line | 2333 NORTH 6TH STREET
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City | GRAND JUNCTION
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State | CO
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Zip | 81501
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Country | US
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Telephone | 970-255-1782
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 62
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City | GRAND JUNCTION
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State | CO
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Zip | 81502-0062
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Country | US
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Telephone | 970-244-2894
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 43536
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 43536
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License Number State | CO
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