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General NPI Number Information
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NPI Number | 1356141758
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Entity Type | Individual
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Provider Name | DOUGLAS ANDERSON RN
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Gender | Male
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 601 BAYONET CIR
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City | MARINA
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State | CA
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Zip | 93933-4600
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Country | US
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Telephone | 831-647-3000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 222021
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City | CARMEL
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State | CA
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Zip | 93922-2021
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Country | US
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Telephone | 831-238-3660
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 287544
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License Number State | CA
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