Provider Demographics
NPI:1043383136
Name:REPPHUN, ANDREA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARIE
Last Name:REPPHUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 DENNIS ST SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5459
Mailing Address - Country:US
Mailing Address - Phone:360-754-6367
Mailing Address - Fax:360-754-6429
Practice Address - Street 1:150 DENNIS ST SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-5459
Practice Address - Country:US
Practice Address - Phone:360-754-6367
Practice Address - Fax:360-754-6429
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1043383136OtherNPI
WA8286536Medicaid
WABR7299185OtherDEA
WAH54400Medicare UPIN
WAH54400Medicare UPIN