Provider Demographics
NPI:1437229408
Name:HUBBARD, ANDREA L (LMP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:HUBBARD
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:PO BOX 1920
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-1920
Mailing Address - Country:US
Mailing Address - Phone:425-820-2110
Mailing Address - Fax:425-512-8174
Practice Address - Street 1:12707 120TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7500
Practice Address - Country:US
Practice Address - Phone:425-820-2110
Practice Address - Fax:425-512-8174
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013440174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist