Healthcare Provider Details

I. General information

NPI: 1265934491
Provider Name (Legal Business Name): DENIKA LYNN ANDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2018
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 2ND AVE NW
NEW BRIGHTON MN
55112-6823
US

IV. Provider business mailing address

649 OLD HIGHWAY 8 NW APT 128
NEW BRIGHTON MN
55112-2871
US

V. Phone/Fax

Practice location:
  • Phone: 612-865-3778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2522825
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: