Healthcare Provider Details

I. General information

NPI: 1689592685
Provider Name (Legal Business Name): TINA LYNN ANDERA FNP/MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 HOWLING MOON WAY UNIT D
CHEYENNE WY
82007-3825
US

IV. Provider business mailing address

1355 HOWLING MOON WAY UNIT D
CHEYENNE WY
82007-3825
US

V. Phone/Fax

Practice location:
  • Phone: 307-640-4144
  • Fax:
Mailing address:
  • Phone: 307-640-4144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number23851
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: