Healthcare Provider Details

I. General information

NPI: 1952450702
Provider Name (Legal Business Name): PATRICIA RUTH ANDERSON CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 TETON LANE
MANKATO MN
56001
US

IV. Provider business mailing address

45 TETON LANE
MANKATO MN
56001
US

V. Phone/Fax

Practice location:
  • Phone: 507-388-7488
  • Fax: 507-388-5680
Mailing address:
  • Phone: 507-388-7488
  • Fax: 507-388-5680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR044736-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: