| NPI | 1245217579 |
|---|---|
| Former Name | ANDREA RENEE TIDRICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IA 01273) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 1273) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2022-03-04 |