Healthcare Provider Details

I. General information

NPI: 1588084792
Provider Name (Legal Business Name): AMBER FAYE ANDERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 NORTHUP WAY
BELLEVUE WA
98004-1463
US

IV. Provider business mailing address

14711 NE 29TH PL SUITE #255
BELLEVUE WA
98007-7666
US

V. Phone/Fax

Practice location:
  • Phone: 425-827-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60452546
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: