Provider Demographics
NPI:1104192772
Name:REICH, ANDREA N (PNP)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:N
Last Name:REICH
Suffix:
Gender:
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412045
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2045
Mailing Address - Country:US
Mailing Address - Phone:314-353-8777
Mailing Address - Fax:314-353-8772
Practice Address - Street 1:6526 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2654
Practice Address - Country:US
Practice Address - Phone:314-353-8777
Practice Address - Fax:314-353-8772
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012005442363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420057535Medicaid