Healthcare Provider Details

I. General information

NPI: 1104823699
Provider Name (Legal Business Name): DEBBIE C. ANDERSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 14TH AVE
LONGVIEW WA
98632-2315
US

IV. Provider business mailing address

PO BOX 249
LONGVIEW WA
98632-7154
US

V. Phone/Fax

Practice location:
  • Phone: 360-501-3601
  • Fax: 360-501-3648
Mailing address:
  • Phone: 360-414-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00119013
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30005930
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: