Provider Demographics
NPI:1104875954
Name:GUNNING, ANDREA M (ARNP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:GUNNING
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S MCCLELLAN ST
Mailing Address - Street 2:#LL10
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2457
Mailing Address - Country:US
Mailing Address - Phone:509-353-3973
Mailing Address - Fax:509-838-8275
Practice Address - Street 1:820 S MCCLELLAN ST
Practice Address - Street 2:#LL10
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2457
Practice Address - Country:US
Practice Address - Phone:509-353-3973
Practice Address - Fax:509-838-8275
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005350363L00000X
WARN 0067490363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9628744Medicaid
WA142417OtherL & I
WAAB14689Medicare ID - Type Unspecified
P11109Medicare UPIN