Provider Demographics
NPI:1740407436
Name:OPALENIK, ANDREA (DO)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:OPALENIK
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 13TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-1610
Mailing Address - Country:US
Mailing Address - Phone:310-990-5941
Mailing Address - Fax:206-787-9007
Practice Address - Street 1:3423 13TH AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-1610
Practice Address - Country:US
Practice Address - Phone:310-990-5941
Practice Address - Fax:206-787-9007
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335384207Q00000X
WAOP00002273208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1740407436Medicaid
WA1740407436Medicaid