Provider Demographics
NPI:1962431171
Name:FJONE, ANDRA LYNN (NP)
Entity type:Individual
Prefix:
First Name:ANDRA
Middle Name:LYNN
Last Name:FJONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 HARVARD STREET. SE WDH 5-140
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA SCHOOL OF NURSING
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0342
Mailing Address - Country:US
Mailing Address - Phone:612-625-1695
Mailing Address - Fax:612-626-6606
Practice Address - Street 1:308 HARVARD ST SE # WDH5-140
Practice Address - Street 2:UNIVERSITY OF MINNESOTA
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0342
Practice Address - Country:US
Practice Address - Phone:612-625-1695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 089101-5363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1035293OtherPREFERRED ONE
MN12-09026OtherMEDICA PRIMARY
MN131138OtherUCARE
MN1858367OtherARAZ
WI43994700Medicaid
MN050925600Medicaid
MN608T3FJOtherBCBS
MT4304001Medicaid
MN12-03086OtherMEDICA CHOICE
MNHP42751OtherHEALTHPARTNERS
MN1858367OtherARAZ
MNHP42751OtherHEALTHPARTNERS