Healthcare Provider Details

I. General information

NPI: 1568502672
Provider Name (Legal Business Name): BARBARA C ANDERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 9TH ST
FLORENCE OR
97439-9470
US

IV. Provider business mailing address

380 9TH ST
FLORENCE OR
97439-9470
US

V. Phone/Fax

Practice location:
  • Phone: 541-997-7134
  • Fax: 541-902-7533
Mailing address:
  • Phone: 541-997-7134
  • Fax: 541-997-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number090007482N1 FNP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: