Healthcare Provider Details

I. General information

NPI: 1033741012
Provider Name (Legal Business Name): ANDREA SKIPWORTH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 S MILDRED ST STE H
TACOMA WA
98465-1634
US

IV. Provider business mailing address

10238 194TH ST E APT R102
GRAHAM WA
98338-7972
US

V. Phone/Fax

Practice location:
  • Phone: 253-301-5270
  • Fax:
Mailing address:
  • Phone: 706-897-5541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN60626360
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61344052
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: