Healthcare Provider Details

I. General information

NPI: 1023645447
Provider Name (Legal Business Name): DAVID ALLEN ANDERSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7746 ORCHARD VILLAGE DR
INDIANAPOLIS IN
46217-2907
US

IV. Provider business mailing address

7746 ORCHARD VILLAGE DR
INDIANAPOLIS IN
46217-2907
US

V. Phone/Fax

Practice location:
  • Phone: 317-985-8265
  • Fax:
Mailing address:
  • Phone: 317-985-8265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number28092581A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: