Provider Demographics
NPI:1215063854
Name:ANDERSON, AMY MICHELLE (DO)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:MICHELLE
Last Name:ANDERSON
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 1:1780 NW MYHRE RD
Mailing Address - Street 2:SUITE 1250
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8676
Mailing Address - Country:US
Mailing Address - Phone:360-692-7919
Mailing Address - Fax:360-692-7960
Practice Address - Street 1:1780 NW MYHRE RD
Practice Address - Street 2:SUITE 1250
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8676
Practice Address - Country:US
Practice Address - Phone:360-692-7919
Practice Address - Fax:360-692-7960
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60164769208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice