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General NPI Number Information
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NPI Number | 1760179295
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Entity Type | Individual
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Provider Name | SASHA ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 2817 ASPEN LAKE DR NE
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City | BLAINE
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State | MN
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Zip | 55449-3100
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Country | US
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Telephone | 651-341-7209
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 476
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City | HUGO
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State | MN
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Zip | 55038-0476
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Country | US
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Telephone | 651-341-7209
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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 | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | BC637425
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License Number State | MN
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