Individual
MRS. ANDREA DAWN BEARDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
Mailing address
805 KENWOOD AVE, FORT WAYNE, IN 46805-2530
(260) 402-1987
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28176632A
IN
363LF0000X
Family Nurse Practitioner
Primary
71002807A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200952160
—
IN
01
—
P00969693
RAILROAD MEDICARE
IN
Enumeration date
11/10/2008
Last updated
05/04/2022
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