Individual
ANDREA K. STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
600 BROADWAY ST, LONGVIEW, WA 98632-3256
(360) 636-4943
Mailing address
1230 7TH AVE, LONGVIEW, WA 98632-3166
(360) 636-6268
(360) 575-6749
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8510075
—
WA
Enumeration date
03/31/2008
Last updated
12/20/2021
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