Healthcare Provider Details

I. General information

NPI: 1386920692
Provider Name (Legal Business Name): EMILY ANDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 EAST 1ST STREET
SALIDA CO
81201
US

IV. Provider business mailing address

448 E 1ST ST
SALIDA CO
81201-2804
US

V. Phone/Fax

Practice location:
  • Phone: 719-207-1398
  • Fax:
Mailing address:
  • Phone: 719-207-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number202109
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: