=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386920692
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY ANDERSON RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2011
-----------------------------------------------------
Last Update Date | 11/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 448 EAST 1ST STREET
-----------------------------------------------------
City | SALIDA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-207-1398
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 448 E 1ST ST
-----------------------------------------------------
City | SALIDA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81201-2804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-207-1398
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WG0000X
-----------------------------------------------------
Taxonomy Name | General Practice Registered Nurse
-----------------------------------------------------
License Number | 202109
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------