Provider Demographics
NPI:1104496389
Name:LANDIS, ANDREA M (PHD, RN, FNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:LANDIS
Suffix:
Gender:F
Credentials:PHD, RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 MAPLE AVE W # 128
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5612
Mailing Address - Country:US
Mailing Address - Phone:206-499-5390
Mailing Address - Fax:
Practice Address - Street 1:99 TREMONT ST
Practice Address - Street 2:
Practice Address - City:MANASSAS PARK
Practice Address - State:VA
Practice Address - Zip Code:20111-1800
Practice Address - Country:US
Practice Address - Phone:703-993-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily