Healthcare Provider Details

I. General information

NPI: 1912013707
Provider Name (Legal Business Name): ANDREA BLATTLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA OTERO

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 RIVERBEND DR STE 300
SPRINGFIELD OR
97477-8800
US

IV. Provider business mailing address

1115 SE 164TH AVE DEPT 358
VANCOUVER WA
98683-8004
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-4332
  • Fax: 541-242-6770
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200450065NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: