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General NPI Number Information
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NPI Number | 1912568205
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Entity Type | Individual
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Provider Name | ANDREA LYN FELLMAN NP-C
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Gender | Female
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 06/26/2019
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Provider Practice Location Address
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Address Line | IDEAL OPTION CLINIC 328 SOUTH STILLAGUAMISH AVE
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City | ARLINGTON
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State | WA
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Zip | 98223-1660
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Country | US
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Telephone | 425-800-8254
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2269
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City | LYNNWOOD
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State | WA
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Zip | 98036-2269
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Country | US
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Telephone | 419-705-2501
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AP60968125
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License Number State | WA
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