Provider Demographics
NPI:1477055101
Name:STEEN-LARSEN, ANDREA FAYE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:FAYE
Last Name:STEEN-LARSEN
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 1:285 SOUTH ST STE J
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5037
Mailing Address - Country:US
Mailing Address - Phone:805-788-8128
Mailing Address - Fax:
Practice Address - Street 1:285 SOUTH ST STE J
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5037
Practice Address - Country:US
Practice Address - Phone:805-788-8128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40063167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician