MEDICARE: SUSAN ANDERSON FNP

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	363LF0000X	Family Nurse Practitioner	813670	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	813670	OTHER	NV	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790428712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ANDERSON FNP

Provider Business Mailing Address
First Line	:	2739 SUNRIDGE HEIGHTS PKWY STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-5043
Country	:	US
Telephone Number	:	702-553-3635
Fax Number	:	833-973-5084

Provider Business Practice Location Address
First Line	:	2739 SUNRIDGE HEIGHTS PKWY STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-5043
Country	:	US
Telephone Number	:	702-553-3635
Fax Number	:	833-973-5084

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

Provider Enumeration Date	:	04/18/2022
Last Update Date	:	05/29/2025

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