Individual
MRS. DEBRA ANDVIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PAC0194
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024067
NDBS
ND
05
—
048592600
—
MN
05
—
16541
—
ND
01
—
212K9AN
MNBS
MN
01
—
P00189293
RAILROAD MEDICARE
ND
Enumeration date
10/24/2006
Last updated
03/04/2009
Update your record
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