Provider Demographics
NPI:1346318326
Name:INDGJERD, ANDREA MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:INDGJERD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:MARIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:2027 W INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-4142
Mailing Address - Country:US
Mailing Address - Phone:509-624-5973
Mailing Address - Fax:509-315-4077
Practice Address - Street 1:2027 W INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4142
Practice Address - Country:US
Practice Address - Phone:509-624-5973
Practice Address - Fax:509-315-4077
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6565MAOtherASURIS-REGENCE
WA0201940OtherLABOR AND INDUSTRIES