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General NPI Number Information
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NPI Number | 1023111606
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Entity Type | Individual
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Provider Name | CHARLOTTE MARIE ANDERSEN MD
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Gender | Female
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 510 4TH STREET S
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City | FARGO
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State | ND
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Zip | 58107
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Country | US
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Telephone | 701-476-7200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 143
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City | BADGER
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State | SD
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Zip | 57214
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Country | US
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Telephone | 605-983-5087
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Fax | 605-983-4796
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 10156
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MDR3657
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License Number State | MO
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