Healthcare Provider Details

I. General information

NPI: 1295373959
Provider Name (Legal Business Name): MICAH FRANKLIN ANDERSON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 NE 137TH AVE
VANCOUVER WA
98682-4933
US

IV. Provider business mailing address

2101 NE 139TH ST STE 360
VANCOUVER WA
98686-2313
US

V. Phone/Fax

Practice location:
  • Phone: 800-813-2000
  • Fax:
Mailing address:
  • Phone: 360-487-1975
  • Fax: 360-487-1975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61201963
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN60306204
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: