Healthcare Provider Details

I. General information

NPI: 1629049796
Provider Name (Legal Business Name): MARTHA M ANDERSON RNC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E ECONOMY RD
MORRISTOWN TN
37814-3756
US

IV. Provider business mailing address

210 E ECONOMY RD
MORRISTOWN TN
37814-3756
US

V. Phone/Fax

Practice location:
  • Phone: 423-307-1468
  • Fax: 423-307-1479
Mailing address:
  • Phone: 423-307-1468
  • Fax: 423-307-1468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN75728
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN6230
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: