Healthcare Provider Details

I. General information

NPI: 1518383728
Provider Name (Legal Business Name): ANNA L WALDNER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA L WALDNER FNP-C

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 05/06/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SEASONS CENTER FOR BEHAVIORAL HEALTH 201 E 11TH STREET
SPENCER IA
51301-0000
US

IV. Provider business mailing address

402 EMMA DR
HARTFORD SD
57033-2061
US

V. Phone/Fax

Practice location:
  • Phone: 712-262-2922
  • Fax:
Mailing address:
  • Phone: 605-413-3089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000995
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG151373
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: