Provider Demographics
NPI:1801384474
Name:ANDERSEN, ANDREA YURIKO (RDN)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:YURIKO
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15211 W PORT ROYALE LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-7011
Mailing Address - Country:US
Mailing Address - Phone:623-341-8546
Mailing Address - Fax:
Practice Address - Street 1:15211 W PORT ROYALE LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-7011
Practice Address - Country:US
Practice Address - Phone:623-341-8546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-28
Last Update Date:2018-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86056677133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered