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NPI Code Detail

MEDICARE: DORETHEA ANDERSON RN

MEDICARE: DORETHEA 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
1164W00000XLicensed Practical Nurse148951OH
2163W00000XRegistered NurseRN.527671OH

General Provider Information

NPI Number : 1952655532
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORETHEA ANDERSON RN
Provider Business Mailing Address
First Line : 4600 MONTGOMERY RD STE 400
Second Line :
City : CINCINNATI
State : OH
Zip : 45212-2600
Country : US
Telephone Number : 513-873-1269
Fax Number :
Provider Business Practice Location Address
First Line : 5850 RIDGE RD
Second Line :
City : PARMA
State : OH
Zip : 44129-3169
Country : US
Telephone Number : 833-510-4357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2012
Last Update Date : 09/19/2023

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