Provider Demographics
NPI:1033741012
Name:SKIPWORTH, ANDREA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:SKIPWORTH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10238 194TH ST E APT R102
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-7972
Mailing Address - Country:US
Mailing Address - Phone:706-897-5541
Mailing Address - Fax:
Practice Address - Street 1:1812 S MILDRED ST STE H
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1634
Practice Address - Country:US
Practice Address - Phone:253-301-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60626360163WM0102X
WAAP61344052363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn