Healthcare Provider Details

I. General information

NPI: 1801783345
Provider Name (Legal Business Name): ANDREA MARIE RALPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10811 W 6TH AVE
AIRWAY HEIGHTS WA
99001-5345
US

IV. Provider business mailing address

1887 WHITNEY MESA DR # 8844
HENDERSON NV
89014-2069
US

V. Phone/Fax

Practice location:
  • Phone: 509-481-4990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberLPN.LP.70015457
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: