Basic Information
| Provider Information | |||||||||
| NPI: | 1316509920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDREWS | ||||||||
| FirstName: | CHARLAINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 390 N UNION BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809095704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7205344221 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6197 LEHMAN DR STE 102 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809183446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192661000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2019 | ||||||||
| LastUpdateDate: | 07/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
No ID Information.