Healthcare Provider Details

I. General information

NPI: 1851698344
Provider Name (Legal Business Name): ELISHA D ANDERSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 MAIN ST
LISBON ND
58054-4244
US

IV. Provider business mailing address

PO BOX 6001
FARGO ND
58108-6001
US

V. Phone/Fax

Practice location:
  • Phone: 701-683-4134
  • Fax: 701-683-4094
Mailing address:
  • Phone: 701-683-4134
  • Fax: 701-683-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR30898
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: