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NPI Code Detail

MEDICARE: MARY ELIZABETH ANDERSON

MEDICARE: MARY ELIZABETH 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
1163W00000XRegistered Nurse403593CA

General Provider Information

NPI Number : 1194374538
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELIZABETH ANDERSON
Provider Business Mailing Address
First Line : 1435 RIVER PARK DR STE 200
Second Line :
City : SACRAMENTO
State : CA
Zip : 95815-4510
Country : US
Telephone Number : 916-286-7011
Fax Number : 916-286-7011
Provider Business Practice Location Address
First Line : 1435 RIVER PARK DR STE 200
Second Line :
City : SACRAMENTO
State : CA
Zip : 95815-4510
Country : US
Telephone Number : 916-286-7011
Fax Number : 916-286-7011
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2019
Last Update Date : 09/09/2019

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Directions to “ MARY ELIZABETH ANDERSON ” Practice Location

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