Provider Demographics
NPI:1154729820
Name:ANDERSON, GEORGIANNA
Entity type:Individual
Prefix:
First Name:GEORGIANNA
Middle Name:
Last Name:ANDERSON
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 1:7309 S CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-9286
Mailing Address - Country:US
Mailing Address - Phone:509-299-5598
Mailing Address - Fax:509-299-6343
Practice Address - Street 1:7309 S CRAIG RD
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-9286
Practice Address - Country:US
Practice Address - Phone:509-299-5598
Practice Address - Fax:509-299-6343
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home