Provider Demographics
NPI:1275982324
Name:WITHAM, ANDREA SHEA (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:SHEA
Last Name:WITHAM
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 SE MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3985
Mailing Address - Country:US
Mailing Address - Phone:503-455-7656
Mailing Address - Fax:503-457-0645
Practice Address - Street 1:753 SE MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3985
Practice Address - Country:US
Practice Address - Phone:503-455-7656
Practice Address - Fax:503-457-0645
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202201834NP-PP363LP0808X
OR202201834NP363LP0808X
AZAP9762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily