Healthcare Provider Details

I. General information

NPI: 1396498366
Provider Name (Legal Business Name): SIERRA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 WOODLEY RD
TOLEDO OH
43606-1169
US

IV. Provider business mailing address

3909 WOODLEY RD
TOLEDO OH
43606-1169
US

V. Phone/Fax

Practice location:
  • Phone: 419-725-3330
  • Fax:
Mailing address:
  • Phone: 567-343-0947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.181413.MEDS-IV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: