Provider Demographics
NPI:1740407436
Name:OPALENIK, ANDREA (DO)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:OPALENIK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6647 NE BAKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2063
Mailing Address - Country:US
Mailing Address - Phone:206-842-1326
Mailing Address - Fax:206-787-9007
Practice Address - Street 1:6647 NE BAKER HILL RD STE 205
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2063
Practice Address - Country:US
Practice Address - Phone:206-842-1326
Practice Address - Fax:206-787-9007
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00002273207QA0505X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1740407436Medicaid
WA1740407436Medicaid