Provider Demographics
NPI:1013206564
Name:CHRISTIAN, ANDREA M
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:M
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 WAINEE ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-2321
Mailing Address - Country:US
Mailing Address - Phone:808-667-1801
Mailing Address - Fax:
Practice Address - Street 1:845 WAINEE ST
Practice Address - Street 2:SUITE 211
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-2321
Practice Address - Country:US
Practice Address - Phone:808-667-1801
Practice Address - Fax:808-661-1157
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10523174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist