Provider Demographics
NPI:1073784047
Name:KREMKO, ANDREA J
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:J
Last Name:KREMKO
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 1:4455 WILLIAMS HWY
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-8797
Mailing Address - Country:US
Mailing Address - Phone:541-761-5478
Mailing Address - Fax:541-956-7566
Practice Address - Street 1:2576 NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-9027
Practice Address - Country:US
Practice Address - Phone:541-761-5478
Practice Address - Fax:541-956-7566
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist