Healthcare Provider Details

I. General information

NPI: 1881363265
Provider Name (Legal Business Name): ANDREA D NIEHOFF CMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 W GARDNER AVE
SPOKANE WA
99201-2059
US

IV. Provider business mailing address

1302 W GARDNER AVE
SPOKANE WA
99201-2059
US

V. Phone/Fax

Practice location:
  • Phone: 509-503-6010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberQ7P4N9Q2
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: