Provider Demographics
NPI:1497222525
Name:HOLMGREN, ANDREA MANCUSO (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MANCUSO
Last Name:HOLMGREN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:MANCUSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 E 2ND ST STE 400
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1577
Mailing Address - Country:US
Mailing Address - Phone:814-877-5600
Mailing Address - Fax:814-877-5601
Practice Address - Street 1:120 E 2ND ST STE 400
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1577
Practice Address - Country:US
Practice Address - Phone:814-877-5600
Practice Address - Fax:814-877-5601
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103584336Medicaid