Healthcare Provider Details

I. General information

NPI: 1720652837
Provider Name (Legal Business Name): JOANNE ANDERSON AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 S MAIN ST
FARMVILLE VA
23901-2211
US

IV. Provider business mailing address

121 NATIONWIDE DR
LYNCHBURG VA
24502-4272
US

V. Phone/Fax

Practice location:
  • Phone: 434-220-1002
  • Fax: 434-220-1003
Mailing address:
  • Phone: 434-384-1862
  • Fax: 434-384-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0024180136
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024180136
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: