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General NPI Number Information
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NPI Number | 1306904818
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Entity Type | Individual
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Provider Name | JANIS D. ANDERSON MA
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 314 CHARLES ST
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City | BRAINERD
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State | MN
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Zip | 56401-3208
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Country | US
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Telephone | 218-855-1247
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Fax | 218-855-1248
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Provider Business Mailing Address
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Address Line | 645 2ND ST SW
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City | PERHAM
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State | MN
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Zip | 56573-1101
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Country | US
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Telephone | 218-346-5384
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Fax |
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 5118
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License Number State | MN
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