Provider Demographics
NPI:1710345111
Name:KISSINGER, ANDREA SHEA (CRT, RRT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:SHEA
Last Name:KISSINGER
Suffix:
Gender:F
Credentials:CRT, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 VIA CABRILLO
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4459
Mailing Address - Country:US
Mailing Address - Phone:520-220-9209
Mailing Address - Fax:
Practice Address - Street 1:1000 VIA CABRILLO
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4459
Practice Address - Country:US
Practice Address - Phone:520-220-9209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered