Healthcare Provider Details

I. General information

NPI: 1871685792
Provider Name (Legal Business Name): SANDY M ANDERSON APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDY MARIE GORDON BSN, MS, MS, APRN-BC

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/17/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7271 N MAIN ST STE 2
DAYTON OH
45415-2561
US

IV. Provider business mailing address

7271 N MAIN ST STE 2
DAYTON OH
45415-2561
US

V. Phone/Fax

Practice location:
  • Phone: 937-991-0082
  • Fax: 937-991-0089
Mailing address:
  • Phone: 937-991-0082
  • Fax: 379-910-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberRN.254376-C0A1
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberRN.254376-C0A1
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN.254376-COA1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: