Provider Demographics
NPI:1114745627
Name:ANDRIYIVNA, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:ANDRIYIVNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 164TH ST SW APT 712
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-3155
Mailing Address - Country:US
Mailing Address - Phone:206-833-5110
Mailing Address - Fax:
Practice Address - Street 1:10751 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98177-4807
Practice Address - Country:US
Practice Address - Phone:206-833-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1795320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness