Healthcare Provider Details

I. General information

NPI: 1851653786
Provider Name (Legal Business Name): ARNETTA V ANDERSON REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 QUEENS DR APT J10
SCHENECTADY NY
12304-3412
US

IV. Provider business mailing address

9 QUEENS DR APT J10 P.O. BOX 208
SCHENECTADY NY
12304-3412
US

V. Phone/Fax

Practice location:
  • Phone: 518-377-0967
  • Fax:
Mailing address:
  • Phone: 518-377-0967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number504636-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number504636-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: