Healthcare Provider Details

I. General information

NPI: 1720217680
Provider Name (Legal Business Name): LENA ANDERSON FERRIS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LENA ROSE ANDERSON

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 S SOUTH ST STE 400
MOUNT AIRY NC
27030
US

IV. Provider business mailing address

PO BOX 1267
MOUNT AIRY NC
27030-1267
US

V. Phone/Fax

Practice location:
  • Phone: 336-783-8030
  • Fax:
Mailing address:
  • Phone: 336-786-4522
  • Fax: 336-789-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5004412
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5004412
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: