Healthcare Provider Details

I. General information

NPI: 1144290685
Provider Name (Legal Business Name): MARLYS A ANDERSON WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 BELLE AVE
MANKATO MN
56001-5287
US

IV. Provider business mailing address

62150 200TH ST
LITCHFIELD MN
55355-6410
US

V. Phone/Fax

Practice location:
  • Phone: 507-387-5581
  • Fax:
Mailing address:
  • Phone: 320-693-3914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR047228-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: