Healthcare Provider Details

I. General information

NPI: 1750151742
Provider Name (Legal Business Name): DANA ANDERSON FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 AIRPARK DR STE 201
REDDING CA
96001-2461
US

IV. Provider business mailing address

20026 PORTERO DR
REDDING CA
96003-7463
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-4034
  • Fax:
Mailing address:
  • Phone: 530-524-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: