MEDICARE: LORI ANDESTAD

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	163W00000X	Registered Nurse	ANDESLR430MB	WA

General Provider Information

NPI Number	:	1750749305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI ANDESTAD

Provider Business Mailing Address
First Line	:	3 BRAMBLE WAY
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-4406
Country	:	US
Telephone Number	:	360-399-8436
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 BRAMBLE WAY
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-4406
Country	:	US
Telephone Number	:	360-399-8436
Fax Number	:

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

Provider Enumeration Date	:	02/10/2016
Last Update Date	:	02/10/2016

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Directions to “ LORI ANDESTAD ” Practice Location

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