Healthcare Provider Details

I. General information

NPI: 1669436622
Provider Name (Legal Business Name): CHRISTINA E ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N 11TH ST
MONTEVIDEO MN
56265-1629
US

IV. Provider business mailing address

824 N 11TH ST
MONTEVIDEO MN
56265-1629
US

V. Phone/Fax

Practice location:
  • Phone: 320-269-8877
  • Fax: 320-269-8186
Mailing address:
  • Phone: 320-269-8877
  • Fax: 320-269-8186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46653
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: