# ANDREA KODAD

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1316904600
- **Gender:** F
- **Credential:** PAC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 1043 | SC | — |
| 363A00000X | Physician Assistant | 990 | NE | Yes |

## Other

- **Enumeration date:** 04/28/2006
- **Last updated:** 10/23/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 990 | STATE LICENSE | NE |
| 05 | — | O354PA | — | SC |