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General NPI Number Information
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NPI Number | 1295262772
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Entity Type | Individual
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Provider Name | EVELYN LAUREN ANDERSEN ARNP
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Gender | Female
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 1259 WEST 20TH AVE
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City | OSHKOSH
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State | WI
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Zip | 54902
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Country | US
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Telephone | 920-651-3600
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Fax | 920-651-3605
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Provider Business Mailing Address
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Address Line | 1259 WEST 20TH AVE
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City | OSHKOSH
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State | WI
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Zip | 54902
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Country | US
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Telephone | 920-651-3600
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Fax | 920-651-3605
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 7801
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 178788-30
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License Number State | WI
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