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NPI Code Detail

MEDICARE: KALEB ANDERSON

MEDICARE:   KALEB  ANDERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NurseLP61426634WA

General Provider Information

NPI Number : 1144095506
Entity Type Code : Individual
Provider Name (Legal Business Name) : KALEB ANDERSON
Provider Business Mailing Address
First Line : 4411 BROWNS POINT BLVD
Second Line :
City : TACOMA
State : WA
Zip : 98422-2041
Country : US
Telephone Number : 253-925-9220
Fax Number :
Provider Business Practice Location Address
First Line : 4411 BROWNS POINT BLVD
Second Line :
City : TACOMA
State : WA
Zip : 98422-2041
Country : US
Telephone Number : 253-925-9220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2023
Last Update Date : 11/16/2023

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Directions to “ KALEB ANDERSON ” Practice Location

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