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General NPI Number Information
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NPI Number | 1477349553
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Entity Type | Individual
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Provider Name | ELIZABETH ANDREA ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 1059 NW HWY
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City | PRINEVILLE
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State | OR
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Zip | 97754
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Country | US
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Telephone | 541-323-5330
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Fax | 541-447-1211
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Provider Business Mailing Address
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Address Line | PO BOX 70
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City | PRINEVILLE
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State | OR
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Zip | 97754-0070
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Country | US
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Telephone | 541-323-5330
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Fax | 541-447-1211
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 114289
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License Number State | OR
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