Basic Information
| Provider Information | |||||||||
| NPI: | 1134208788 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELONG | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7210 40TH ST W STE 100 | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984664319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535640170 | ||||||||
| FaxNumber: | 2532074240 | ||||||||
| Practice Location | |||||||||
| Address1: | 7210 40TH ST W STE 100 | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984664319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535640170 | ||||||||
| FaxNumber: | 2532074240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN00130896 | WA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | AP30006869 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1043000 | 05 | WA | MEDICAID | 224918 | 01 | WA | L & I | OTHER | 8939741 | 01 | WA | CRIME VICTIMS | OTHER | 8939742 | 01 | WA | CRIME VICTIMS | OTHER | 0192629 | 01 | WA | L & I | OTHER | 0192630 | 01 | WA | L & I | OTHER |