Provider Demographics
NPI:1124592431
Name:GRUSZECKI, ANDREA E (ND)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:E
Last Name:GRUSZECKI
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SW 5TH PL APT A302
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5803
Mailing Address - Country:US
Mailing Address - Phone:540-379-9796
Mailing Address - Fax:
Practice Address - Street 1:200 SW 5TH PL APT A302
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5803
Practice Address - Country:US
Practice Address - Phone:540-379-9796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60869102175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath