Provider Demographics
NPI:1336507664
Name:CONNOR, ANDREW (NREMT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CONNOR
Suffix:
Gender:M
Credentials:NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7015 40TH ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-5012
Mailing Address - Country:US
Mailing Address - Phone:253-565-1184
Mailing Address - Fax:
Practice Address - Street 1:7015 40TH ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-5012
Practice Address - Country:US
Practice Address - Phone:253-565-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAEMT.ES.60599608146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic