Healthcare Provider Details

I. General information

NPI: 1578773784
Provider Name (Legal Business Name): JUDITH ANNE ANDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N MARTIN AVE
TUCSON AZ
85721-0001
US

IV. Provider business mailing address

16530 S CHINOOK PL
BENSON AZ
85602-7208
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-7571
  • Fax:
Mailing address:
  • Phone: 520-586-1355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License NumberRN040336
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: