Provider Demographics
NPI:1982060539
Name:BINGHAM, ANDREW JOHN DAVID (BA)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JOHN DAVID
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 S REGAL ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7738
Mailing Address - Country:US
Mailing Address - Phone:360-789-3587
Mailing Address - Fax:509-789-3780
Practice Address - Street 1:4202 S REGAL ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223
Practice Address - Country:US
Practice Address - Phone:360-789-3587
Practice Address - Fax:509-789-3780
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC60554663376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide