Healthcare Provider Details

I. General information

NPI: 1922693746
Provider Name (Legal Business Name): ANDREA WALKER PSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 NW MADRAS HWY
PRINEVILLE OR
97754-1416
US

IV. Provider business mailing address

PO BOX 1710
REDMOND OR
97756-0516
US

V. Phone/Fax

Practice location:
  • Phone: 541-323-5330
  • Fax:
Mailing address:
  • Phone: 541-516-4087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberTHW000003514
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: