Healthcare Provider Details

I. General information

NPI: 1437234127
Provider Name (Legal Business Name): CATHERINE ANDERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 19TH AVE SW
WILLMAR MN
56201-5005
US

IV. Provider business mailing address

3153 8TH ST NE
WILLMAR MN
56201-9210
US

V. Phone/Fax

Practice location:
  • Phone: 320-214-1100
  • Fax:
Mailing address:
  • Phone: 320-235-5328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR095294-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: