Provider Demographics
NPI:1508823683
Name:ANDREWS, MARK (ARNP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:ARNP
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 98886
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98496-8886
Mailing Address - Country:US
Mailing Address - Phone:253-589-6484
Mailing Address - Fax:253-984-1079
Practice Address - Street 1:4901 108TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3724
Practice Address - Country:US
Practice Address - Phone:253-589-6484
Practice Address - Fax:253-984-1079
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9649211Medicaid
WAP00353626OtherRR MEDICARE
WA0208983OtherL&I
WAG8860975Medicare PIN
WAQ70708Medicare UPIN
WAG8809455Medicare UPIN