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NPI Code Detail

MEDICARE: MS. SANDRA L ANDERSON ANP-BC

MEDICARE: MS. SANDRA L ANDERSON ANP-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 Practitioner5336CT
2363LA2200XAdult Health Nurse Practitioner5012667NC

General Provider Information

NPI Number : 1639513948
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SANDRA L ANDERSON ANP-BC
Provider Business Mailing Address
First Line : 11350 MCCORMICK RD
Second Line : EXECUTIVE PLAZA 1, SUITE 501
City : HUNT VALLEY
State : MD
Zip : 21031
Country : US
Telephone Number : 410-329-1071
Fax Number : 410-329-1054
Provider Business Practice Location Address
First Line : 1168 E CUTLAR XING
Second Line :
City : LELAND
State : NC
Zip : 28451-6484
Country : US
Telephone Number : 910-332-3800
Fax Number : 910-251-0421
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2013
Last Update Date : 01/09/2020

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