Individual
ANDREA WISE RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1600 W NORTHWEST HWY, STE 900, GRAPEVINE, TX 76051-8112
(817) 347-2530
(817) 488-5096
Mailing address
PO BOX 733784, DALLAS, TX 75373-3784
(682) 885-1855
(682) 885-1396
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04257
TX
Other
Enumeration date
12/14/2005
Last updated
04/27/2021
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