MEDICARE: DANIELLE ANDERSON CRNP

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	363L00000X	Nurse Practitioner	F01200439	AL

General Provider Information

NPI Number	:	1457991168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE ANDERSON CRNP

Provider Business Mailing Address
First Line	:	406 TAYLOR ST STE A
Second Line	:
City	:	SCOTTSBORO
State	:	AL
Zip	:	35768-2406
Country	:	US
Telephone Number	:	256-574-1050
Fax Number	:	256-574-1045

Provider Business Practice Location Address
First Line	:	406 TAYLOR ST STE A
Second Line	:
City	:	SCOTTSBORO
State	:	AL
Zip	:	35768-2406
Country	:	US
Telephone Number	:	256-574-1050
Fax Number	:	256-574-1045

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

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	02/03/2021

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Directions to “ DANIELLE ANDERSON CRNP” Practice Location

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