Provider Demographics
NPI:1780100503
Name:ANDREW, MATRONA MARLENE
Entity type:Individual
Prefix:PROF
First Name:MATRONA
Middle Name:MARLENE
Last Name:ANDREW
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:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576-0130
Mailing Address - Country:US
Mailing Address - Phone:907-842-5201
Mailing Address - Fax:
Practice Address - Street 1:WALLACE STREET
Practice Address - Street 2:
Practice Address - City:NEW STUYAHOK
Practice Address - State:AK
Practice Address - Zip Code:99636
Practice Address - Country:US
Practice Address - Phone:907-693-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor