Healthcare Provider Details

I. General information

NPI: 1508632563
Provider Name (Legal Business Name): CARLA MARIE ANDERSON ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W BROADWAY ST STE 240
MOUNT PLEASANT MI
48858-2575
US

IV. Provider business mailing address

113 W BROADWAY ST STE 240
MOUNT PLEASANT MI
48858-2575
US

V. Phone/Fax

Practice location:
  • Phone: 989-600-0576
  • Fax:
Mailing address:
  • Phone: 989-600-0576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number91104DTN
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: