Provider Demographics
NPI:1154369619
Name:OROCK, ANDINWOH (PA-C)
Entity type:Individual
Prefix:
First Name:ANDINWOH
Middle Name:
Last Name:OROCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDINWOH
Other - Middle Name:
Other - Last Name:BARNABY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:595 W LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7015
Practice Address - Country:US
Practice Address - Phone:702-566-5500
Practice Address - Fax:702-558-7238
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA931363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1154369619Medicaid
NVPA931OtherNEVADA STATE LICENSE
NV105580Medicare UPIN
NVEU152YMedicare PIN
NV101768Medicare ID - Type Unspecified
Q58383Medicare UPIN
NV1154369619Medicaid