Healthcare Provider Details

I. General information

NPI: 1508038548
Provider Name (Legal Business Name): ARTHERLENE ANDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 KANSAS ST APT 2
SAN DIEGO CA
92116-4210
US

IV. Provider business mailing address

4540 KANSAS ST APT 2
SAN DIEGO CA
92116-4210
US

V. Phone/Fax

Practice location:
  • Phone: 619-615-0439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number550101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: