MEDICARE: GINA ANDERSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	406685	NY

General Provider Information

NPI Number	:	1447572938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA ANDERSON RN

Provider Business Mailing Address
First Line	:	527 DEER PARK RD
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-5207
Country	:	US
Telephone Number	:	631-654-0789
Fax Number	:

Provider Business Practice Location Address
First Line	:	527 DEER PARK RD
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-5207
Country	:	US
Telephone Number	:	631-654-0789
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2010
Last Update Date	:	02/24/2010

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