Physician Compare National (NPI:1619353612)

HEALTHCARE PROVIDER: DONNA NICOLE ANDERSON FNP, PMHNP-BC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1619353612
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0042593956
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170220000001
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ANDERSON
	Individual professional last name
Provider First Name	DONNA
	Individual professional first name
Provider Middle Name	N
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2015
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	123 SUNNYBROOK RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 140
	Group Practice or individual's line 2 address
City	RALEIGH
	Group Practice or individual's city
State	NC
	Group Practice or individual's state
Zip Code	276102784
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	340069
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WAKEMED, RALEIGH CAMPUS
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y