Healthcare Provider Details

I. General information

NPI: 1295889665
Provider Name (Legal Business Name): VERA ROSE 'ANDERSON APRN, BC, CS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2731 NUGGET AVE
LAKE ISABELLA CA
93240-2632
US

IV. Provider business mailing address

PO BOX 347
KERNVILLE CA
93238-0347
US

V. Phone/Fax

Practice location:
  • Phone: 760-379-3412
  • Fax:
Mailing address:
  • Phone: 760-376-3662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number199429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: