Provider Demographics
NPI:1700481843
Name:NEWBAUER, ANDREA M
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:M
Last Name:NEWBAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:PIELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:24265 HUMMINGBIRD ST NW
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:MN
Mailing Address - Zip Code:55070-8400
Mailing Address - Country:US
Mailing Address - Phone:763-772-2824
Mailing Address - Fax:
Practice Address - Street 1:8600 114TH AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3869
Practice Address - Country:US
Practice Address - Phone:763-422-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist