Healthcare Provider Details

I. General information

NPI: 1043891203
Provider Name (Legal Business Name): LONA DENISE ANDERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 PLAYER DR
TROY MI
48085-3370
US

IV. Provider business mailing address

1276 PLAYER DR
TROY MI
48085-3370
US

V. Phone/Fax

Practice location:
  • Phone: 248-250-2552
  • Fax:
Mailing address:
  • Phone: 248-250-2552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704248492
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: