Provider Demographics
NPI:1326211913
Name:WILLIAMS, ANDREA LANELLE (LMP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LANELLE
Last Name:WILLIAMS
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 1:418 EAST NORTH BEND WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-2388
Mailing Address - Country:US
Mailing Address - Phone:425-888-6846
Mailing Address - Fax:425-888-6932
Practice Address - Street 1:418 EAST NORTH BEND WAY
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-2388
Practice Address - Country:US
Practice Address - Phone:425-888-6846
Practice Address - Fax:425-888-6932
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013392225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0151474OtherL&I