Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OP60333805 | WA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | OP60333805 | WA |
NPI | 1235440223 |
---|---|
Provider Name | Dr. Andrea J Chatburn |
First Address | Liberty Lake, WA 99019-0462 |
Second Address | Spokane, WA 99204-2307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2010 |
Last Update Date | 03/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES000 | RES000 (01) |