=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437229408
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA L HUBBARD LMP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 10/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12707 120TH AVE NE STE 100
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98034-7500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-820-2110
-----------------------------------------------------
Fax | 425-512-8174
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1920
-----------------------------------------------------
City | EVERETT
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98206-1920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-820-2110
-----------------------------------------------------
Fax | 425-512-8174
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MA00013440
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------