Provider Demographics
NPI:1043324684
Name:ANDRAS, DWAYNE (NP)
Entity type:Individual
Prefix:
First Name:DWAYNE
Middle Name:
Last Name:ANDRAS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:DWAYNE
Other - Middle Name:
Other - Last Name:ANDRAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 5478
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-5478
Mailing Address - Country:US
Mailing Address - Phone:985-493-4740
Mailing Address - Fax:985-446-5033
Practice Address - Street 1:602 N ACADIA RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301
Practice Address - Country:US
Practice Address - Phone:985-493-4740
Practice Address - Fax:985-449-2535
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA76615-3364174400000X
LAAP03364363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1569364Medicaid
LA5X763Medicare ID - Type Unspecified
LA1569364Medicaid