Provider Demographics
NPI:1114228855
Name:PIKE, ANDREA LYNN (LMP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LYNN
Last Name:PIKE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 11TH ST
Mailing Address - Street 2:STE. 4
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7078
Mailing Address - Country:US
Mailing Address - Phone:360-671-5562
Mailing Address - Fax:360-766-4444
Practice Address - Street 1:1209 11TH ST
Practice Address - Street 2:STE. 4
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7078
Practice Address - Country:US
Practice Address - Phone:360-671-5562
Practice Address - Fax:360-766-4444
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004144172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker