Healthcare Provider Details

I. General information

NPI: 1659019131
Provider Name (Legal Business Name): COURTNEY ANDERSEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVE
TUCSON AZ
85724-0001
US

IV. Provider business mailing address

1501 N CAMPBELL AVE
TUCSON AZ
85724-5073
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-7399
  • Fax: 520-626-5652
Mailing address:
  • Phone: 520-626-7399
  • Fax: 520-626-5652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR3735
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: