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NPI Code Detail

MEDICARE: MS. NINA JEAN ANDERSON MSN, RNP, APRN-BC

MEDICARE: MS. NINA JEAN ANDERSON MSN, RNP, APRN-BC
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
1363LA2200XAdult Health Nurse PractitionerRNP 2505AZ
2363LA2200XAdult Health Nurse Practitioner418AK
3363LA2200XAdult Health Nurse PractitionerRN134507AZ
4363LA2200XAdult Health Nurse Practitioner16903AK

General Provider Information

NPI Number : 1639298417
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NINA JEAN ANDERSON MSN, RNP, APRN-BC
Provider Business Mailing Address
First Line : 8145 HOLLOW RIDGE RD
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-6407
Country : US
Telephone Number : 928-714-1818
Fax Number : 928-714-1818
Provider Business Practice Location Address
First Line : 8145 HOLLOW RIDGE RD
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-6407
Country : US
Telephone Number : 928-714-1818
Fax Number : 928-714-1818
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2007
Last Update Date : 07/08/2007

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