Provider Demographics
NPI:1215023007
Name:DOMINEY, ANDREA MEAD (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MEAD
Last Name:DOMINEY
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 1:1807 N HUTCHINSON RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2444
Mailing Address - Country:US
Mailing Address - Phone:509-456-7414
Mailing Address - Fax:509-624-0763
Practice Address - Street 1:1807 N HUTCHINSON RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2444
Practice Address - Country:US
Practice Address - Phone:509-456-7414
Practice Address - Fax:509-624-0763
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-8263207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003663100Medicaid
WA8159071Medicaid
ID003663100Medicaid
WA8159071Medicaid