Healthcare Provider Details

I. General information

NPI: 1124853577
Provider Name (Legal Business Name): LANI ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 SOUTHWESTERN RUN
YOUNGSTOWN OH
44514-3688
US

IV. Provider business mailing address

807 SOUTHWESTERN RUN
YOUNGSTOWN OH
44514-3688
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-0059
  • Fax:
Mailing address:
  • Phone: 330-729-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN.428612
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN.CNP.0037454
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: