Provider Demographics
NPI:1144272766
Name:ANDROUS JUNK, DARLENE M (PA/C)
Entity type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:M
Last Name:ANDROUS JUNK
Suffix:
Gender:F
Credentials:PA/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 SOLANO STREET
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021
Mailing Address - Country:US
Mailing Address - Phone:530-824-7845
Mailing Address - Fax:530-824-4084
Practice Address - Street 1:2126 SOLANO STREET
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021
Practice Address - Country:US
Practice Address - Phone:530-824-7845
Practice Address - Fax:530-824-4084
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15059363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ20967ZMedicare ID - Type Unspecified