Provider Demographics
NPI:1164755336
Name:ANDREOSKY, HOLLY BETH (NP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:BETH
Last Name:ANDREOSKY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9495 SW LOCUST ST STE A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6683
Mailing Address - Country:US
Mailing Address - Phone:503-636-9011
Mailing Address - Fax:503-636-3952
Practice Address - Street 1:9495 SW LOCUST ST STE A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-6683
Practice Address - Country:US
Practice Address - Phone:503-636-9011
Practice Address - Fax:503-636-3952
Is Sole Proprietor?:No
Enumeration Date:2009-09-06
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200950110NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily