=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528580206
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARLESA ANDERSON LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 716 E GRIFFIN AVE
-----------------------------------------------------
City | ATTAPULGUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 39815-2424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-726-7599
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 716 E GRIFFIN AVE
-----------------------------------------------------
City | ATTAPULGUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 39815-2424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-726-7599
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | PN5210158
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------