Provider Demographics
NPI:1306130653
Name:HAFNER-MISHKIN, ANDREA R (ACNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:HAFNER-MISHKIN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:R
Other - Last Name:HAFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-2104
Mailing Address - Country:US
Mailing Address - Phone:207-361-7140
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005
Practice Address - Country:US
Practice Address - Phone:207-283-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP111020363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care