Healthcare Provider Details

I. General information

NPI: 1457123648
Provider Name (Legal Business Name): JANICE ANDERSON MLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 FLATLANDERS WAY
RICHMOND ME
04357-3039
US

IV. Provider business mailing address

PO BOX 93
RICHMOND ME
04357-0093
US

V. Phone/Fax

Practice location:
  • Phone: 207-356-5227
  • Fax:
Mailing address:
  • Phone: 207-356-5227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberSU43865
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number017000-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number02239954
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: