Healthcare Provider Details

I. General information

NPI: 1588643084
Provider Name (Legal Business Name): LANA LOUISE ANDERSEN CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 W EL CAMINITO DR
PHOENIX AZ
85021-5257
US

IV. Provider business mailing address

PO BOX 39482
PHOENIX AZ
85069-9482
US

V. Phone/Fax

Practice location:
  • Phone: 602-942-6166
  • Fax: 602-942-6188
Mailing address:
  • Phone: 602-942-6166
  • Fax: 602-942-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP2800X
TaxonomyPerioperative Clinical Nurse Specialist
License NumberRN050320
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: