Healthcare Provider Details

I. General information

NPI: 1902218324
Provider Name (Legal Business Name): CALEB ANDERSON AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 LAUREL ST SUITE A250
DES MOINES IA
50314-3017
US

IV. Provider business mailing address

5880 UNIVERSITY AVE
WEST DES MOINES IA
50266-8209
US

V. Phone/Fax

Practice location:
  • Phone: 515-235-5000
  • Fax:
Mailing address:
  • Phone: 515-633-3835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberH136852
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number209011352
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: