Provider Demographics
NPI:1811230667
Name:DEANDRADE, HEIDI (LMP)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:DEANDRADE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 34TH AVE
Mailing Address - Street 2:#B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5138
Mailing Address - Country:US
Mailing Address - Phone:206-280-4147
Mailing Address - Fax:
Practice Address - Street 1:1125 34TH AVE
Practice Address - Street 2:#B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5138
Practice Address - Country:US
Practice Address - Phone:206-280-4147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-30
Last Update Date:2013-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022754174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist