Healthcare Provider Details

I. General information

NPI: 1407597313
Provider Name (Legal Business Name): ANNETTE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 CROWN POINT CIR STE 14
GRASS VALLEY CA
95945-9526
US

IV. Provider business mailing address

809 REDWOOD AVE
WHEATLAND CA
95692-9444
US

V. Phone/Fax

Practice location:
  • Phone: 530-478-0900
  • Fax:
Mailing address:
  • Phone: 530-413-3119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: