Provider Demographics
NPI:1689793432
Name:BLACK, ANDREA (ND)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:ND
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 1039
Mailing Address - Street 2:
Mailing Address - City:OKANOGAN
Mailing Address - State:WA
Mailing Address - Zip Code:98840-1039
Mailing Address - Country:US
Mailing Address - Phone:509-422-3700
Mailing Address - Fax:509-422-3701
Practice Address - Street 1:214 PINE STREET
Practice Address - Street 2:
Practice Address - City:OKANOGAN
Practice Address - State:WA
Practice Address - Zip Code:98840
Practice Address - Country:US
Practice Address - Phone:509-422-3700
Practice Address - Fax:509-422-3701
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000538133N00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered175F00000XOther Service ProvidersNaturopath