Provider Demographics
NPI:1063696318
Name:TRADER-MCKENNA, ANDREA CORINNE (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:CORINNE
Last Name:TRADER-MCKENNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:CORINNE
Other - Last Name:TRADER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 842
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:CA
Mailing Address - Zip Code:95694-0842
Mailing Address - Country:US
Mailing Address - Phone:707-410-8519
Mailing Address - Fax:
Practice Address - Street 1:23 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:CA
Practice Address - Zip Code:95694-1722
Practice Address - Country:US
Practice Address - Phone:530-795-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87561261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health