Healthcare Provider Details

I. General information

NPI: 1588318067
Provider Name (Legal Business Name): CHRISTIN ANDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CORDAGE PARK CIR STE 115
PLYMOUTH MA
02360-7318
US

IV. Provider business mailing address

10 CORDAGE PARK CIR STE 115
PLYMOUTH MA
02360-7318
US

V. Phone/Fax

Practice location:
  • Phone: 508-778-5470
  • Fax:
Mailing address:
  • Phone: 508-778-5470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN270985
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: