Provider Demographics
NPI:1396479465
Name:MCVICAR, ANDREA MAE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MAE
Last Name:MCVICAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 HEDGESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2339
Mailing Address - Country:US
Mailing Address - Phone:210-906-2727
Mailing Address - Fax:
Practice Address - Street 1:9643 HUEBNER RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1752
Practice Address - Country:US
Practice Address - Phone:210-614-8222
Practice Address - Fax:210-614-8228
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily