Healthcare Provider Details

I. General information

NPI: 1003883182
Provider Name (Legal Business Name): CHARA J ANDERSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 E NICOLLET BLVD STE 100
BURNSVILLE MN
55337-6749
US

IV. Provider business mailing address

2550 UNIVERSITY AVE W STE 110N
SAINT PAUL MN
55114-2001
US

V. Phone/Fax

Practice location:
  • Phone: 952-892-7190
  • Fax: 952-892-7956
Mailing address:
  • Phone: 651-602-5309
  • Fax: 651-222-6786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR126603-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: