Provider Demographics
NPI:1730168220
Name:MACFADDEN, ANDREA M (APN, BC)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:M
Last Name:MACFADDEN
Suffix:
Gender:F
Credentials:APN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 MERION AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1410
Mailing Address - Country:US
Mailing Address - Phone:856-428-1713
Mailing Address - Fax:856-428-1085
Practice Address - Street 1:139 MERION AVE
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1410
Practice Address - Country:US
Practice Address - Phone:856-428-1713
Practice Address - Fax:856-428-1085
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00051300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075262Medicare UPIN