Doctor Name: | ANDREA GAYE LANDON |
NPI Number: | 1811166028 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 559141 |
Business Practice Address: | 105 Fresh Meadow Dr Trophy Club, TX - 762625530 |
Business Phone Number: | 8179076553 |
Business Fax Number: | |
Mailing Address: | 105 Fresh Meadow Dr, TROPHY CLUB |
State: | TX |
Postal Code: | 762625530 |
Phone Number: | 8179076553 |
Fax Number: | |
NPI Enumeration Date: | 02/22/2008 |
NPI Last Update Date: | 02/22/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 559141 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |