Healthcare Provider Details

I. General information

NPI: 1063864569
Provider Name (Legal Business Name): ANDREA HARTFORD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 S LAPEER RD
LAKE ORION MI
48360-1437
US

IV. Provider business mailing address

6002 WESTGATE BLVD STE 230
TACOMA WA
98406-2572
US

V. Phone/Fax

Practice location:
  • Phone: 248-845-4237
  • Fax: 248-693-3683
Mailing address:
  • Phone: 253-761-2244
  • Fax: 253-761-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101027793
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOP61292581
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: