Provider Demographics
NPI:1144232513
Name:FRIESEN, ANDREA TIFFANY (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:TIFFANY
Last Name:FRIESEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:TIFFANY
Other - Last Name:STEWART-FRIESEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4114 BRIDGEPORT WAY W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4315
Mailing Address - Country:US
Mailing Address - Phone:253-564-4157
Mailing Address - Fax:253-220-2491
Practice Address - Street 1:4114 BRIDGEPORT WAY W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4315
Practice Address - Country:US
Practice Address - Phone:253-564-8100
Practice Address - Fax:253-564-8387
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043696207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8400574Medicaid
WA8400574Medicaid
WA8805589Medicare ID - Type Unspecified