Provider Demographics
NPI:1962625723
Name:WEINER, ANDREA CLAIRE (NMD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:CLAIRE
Last Name:WEINER
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26605
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85068
Mailing Address - Country:US
Mailing Address - Phone:602-615-0554
Mailing Address - Fax:
Practice Address - Street 1:1880 E MORTEN AVE UNIT 230
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4616
Practice Address - Country:US
Practice Address - Phone:602-615-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ01-639175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath