Healthcare Provider Details

I. General information

NPI: 1750420824
Provider Name (Legal Business Name): MARY E ANDERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 PEMBERTON HILL RD SUITE 101
APEX NC
27502-4268
US

IV. Provider business mailing address

1071 PEMBERTON HILL RD SUITE 101
APEX NC
27502-4268
US

V. Phone/Fax

Practice location:
  • Phone: 919-363-6060
  • Fax: 919-363-6040
Mailing address:
  • Phone: 919-363-6060
  • Fax: 919-363-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number200240
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: