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: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 KIMEL PARK DR STE 140
WINSTON SALEM NC
27103-6946
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-277-2225
  • Fax:
Mailing address:
  • Phone: 844-266-8268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: