MEDICARE: ANDREA J CHRISMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)		OR

General Provider Information

NPI Number	:	1487500104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA J CHRISMAN

Provider Business Mailing Address
First Line	:	2620 E 14TH ST
Second Line	:
City	:	THE DALLES
State	:	OR
Zip	:	97058-4003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 E 14TH ST
Second Line	:
City	:	THE DALLES
State	:	OR
Zip	:	97058-4003
Country	:	US
Telephone Number	:	541-615-1775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ ANDREA J CHRISMAN ” Practice Location

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