Healthcare Provider Details

I. General information

NPI: 1992217152
Provider Name (Legal Business Name): MS. RACHEL RENEE ANDRINGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19102 WA-410
BONNEY LAKE WA
98391
US

IV. Provider business mailing address

12316 239TH AVE E
BUCKLEY WA
98321-9398
US

V. Phone/Fax

Practice location:
  • Phone: 253-863-6378
  • Fax:
Mailing address:
  • Phone: 253-258-1058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number60731730
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: