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General NPI Number Information
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NPI Number | 1639694532
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Entity Type | Individual
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Provider Name | ANASARA HENRY DNP, AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/11/2017
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Last Update Date | 09/07/2017
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Provider Practice Location Address
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Address Line | 4500 N LEWIS AVE
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City | SIOUX FALLS
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State | SD
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Zip | 57104-7111
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Country | US
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Telephone | 605-322-4669
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Fax |
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Provider Business Mailing Address
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Address Line | 25124 170TH ST
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City | LE MARS
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State | IA
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Zip | 51031-8631
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Country | US
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Telephone | 712-333-5127
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | H123464
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License Number State | IA
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