Provider Demographics
NPI:1184737447
Name:CURTIS-GIBSON, ANDREA THANDIWE (LMP)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:THANDIWE
Last Name:CURTIS-GIBSON
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 1:3830 NE 33RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1753
Mailing Address - Country:US
Mailing Address - Phone:503-467-6171
Mailing Address - Fax:
Practice Address - Street 1:3830 NE 33RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-1753
Practice Address - Country:US
Practice Address - Phone:503-467-6171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020060174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist