Provider Demographics
NPI:1174239594
Name:ANDREASSEN, BECCA (CPM, LTM)
Entity type:Individual
Prefix:
First Name:BECCA
Middle Name:
Last Name:ANDREASSEN
Suffix:
Gender:F
Credentials:CPM, LTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2362 JAMES AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-1959
Mailing Address - Country:US
Mailing Address - Phone:612-643-0693
Mailing Address - Fax:
Practice Address - Street 1:2362 JAMES AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-1959
Practice Address - Country:US
Practice Address - Phone:612-643-0693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1086176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife