MEDICARE: CHRISTA M ANDREWS LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	5616	AK

General Provider Information

NPI Number	:	1699923714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTA M ANDREWS LPN

Provider Business Mailing Address
First Line	:	PO BOX 1049
Second Line	:
City	:	WILLOW
State	:	AK
Zip	:	99688-1049
Country	:	US
Telephone Number	:	907-495-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	MILE 67 PARKS HWY & NANCY LAKE PKWY
Second Line	:
City	:	WILLOW
State	:	AK
Zip	:	99688-0000
Country	:	US
Telephone Number	:	907-495-4100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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