Healthcare Provider Details

I. General information

NPI: 1891215836
Provider Name (Legal Business Name): ABBEY L ANDERSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 DEMERS AVE
EAST GRAND FORKS MN
56721
US

IV. Provider business mailing address

2151 36TH AVE S APT 108
GRAND FORKS ND
58201-7171
US

V. Phone/Fax

Practice location:
  • Phone: 218-773-6800
  • Fax:
Mailing address:
  • Phone: 701-789-1461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5184
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: