Provider Demographics
NPI:1053177535
Name:MOONEY, ANDREA LEIGH
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEIGH
Last Name:MOONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12006 SE BUSH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-2142
Mailing Address - Country:US
Mailing Address - Phone:561-352-4040
Mailing Address - Fax:
Practice Address - Street 1:5721 NE 138TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-3495
Practice Address - Country:US
Practice Address - Phone:503-261-2090
Practice Address - Fax:503-261-2040
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200542374RN163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy