Provider Demographics
NPI:1558019448
Name:TRAMMELL, ANDRA
Entity Type:Individual
Prefix:
First Name:ANDRA
Middle Name:
Last Name:TRAMMELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-3151
Mailing Address - Country:US
Mailing Address - Phone:307-679-4066
Mailing Address - Fax:
Practice Address - Street 1:1221 KILAUEA AVE STE 60
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4264
Practice Address - Country:US
Practice Address - Phone:808-865-1894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
HI663103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst