Provider Demographics
NPI:1992907372
Name:ANDRECHAK, LAUREL ANN (FNP, PSYCH NP)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:ANN
Last Name:ANDRECHAK
Suffix:
Gender:F
Credentials:FNP, PSYCH NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2431
Mailing Address - Country:US
Mailing Address - Phone:208-799-5700
Mailing Address - Fax:208-799-5758
Practice Address - Street 1:915 1ST AVE S
Practice Address - Street 2:CENTER FOR MENTAL HEALTH
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3705
Practice Address - Country:US
Practice Address - Phone:406-761-2100
Practice Address - Fax:406-761-2107
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN20513363LF0000X
MTRN20513 MT363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000373471OtherBLUE CROSS-SHIELD OF MONTANA
MTMA0256277 MA2016841OtherDEA REGISTRATION NUMBER
MT011003054Medicare PIN
MTMA0256277 MA2016841OtherDEA REGISTRATION NUMBER