Healthcare Provider Details

I. General information

NPI: 1013302496
Provider Name (Legal Business Name): MICHELLE ANDERSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 FITZWATERTOWN RD #A
WILLOW GROVE PA
19090-1338
US

IV. Provider business mailing address

735 FITZWATERTOWN RD #A
WILLOW GROVE PA
19090-1338
US

V. Phone/Fax

Practice location:
  • Phone: 215-657-2012
  • Fax:
Mailing address:
  • Phone: 215-657-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014624
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: