Healthcare Provider Details

I. General information

NPI: 1629166897
Provider Name (Legal Business Name): ANDREA LITTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CTR FITZSIMMONS DR
TACOMA WA
98431-1100
US

IV. Provider business mailing address

13B CHASE LN
LAKEWOOD WA
98498-1189
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-1237
  • Fax: 253-968-0974
Mailing address:
  • Phone: 253-589-9690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number494219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: