Healthcare Provider Details

I. General information

NPI: 1124429089
Provider Name (Legal Business Name): PATRICIA ANDERSON RN, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 UNION ST NE
CHATFIELD MN
55923-1054
US

IV. Provider business mailing address

625 UNION ST NE
CHATFIELD MN
55923-1054
US

V. Phone/Fax

Practice location:
  • Phone: 507-421-2495
  • Fax:
Mailing address:
  • Phone: 507-421-2495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR 137200-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: