Provider Demographics
NPI:1811668965
Name:MATTHEWS, ANDRE SAINT PATRICK
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:SAINT PATRICK
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 2ND AVE W APT 102
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3346
Mailing Address - Country:US
Mailing Address - Phone:425-524-8661
Mailing Address - Fax:
Practice Address - Street 1:216 JAMES ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-5102
Practice Address - Country:US
Practice Address - Phone:206-464-6454
Practice Address - Fax:206-652-1236
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACM.60941589374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician