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General NPI Number Information
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NPI Number | 1992285605
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Entity Type | Individual
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Provider Name | MICHAEL ANDERSON I FNP
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Gender | Male
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 2650 N TENAYA WAY STE 208
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City | LAS VEGAS
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State | NV
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Zip | 89128-1104
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Country | US
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Telephone | 702-360-2100
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Fax | 702-360-3201
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Provider Business Mailing Address
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Address Line | 12700 PARK CENTRAL DR STE 1210
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City | DALLAS
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State | TX
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Zip | 75251-1522
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Country | US
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Telephone | 702-360-2763
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 843338
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1118851
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License Number State | TX
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