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NPI Code Detail

MEDICARE: ALISHA ANDERSON

MEDICARE: ALISHA 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
1174400000XSpecialist

General Provider Information

NPI Number : 1447772215
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALISHA ANDERSON
Provider Business Mailing Address
First Line : 891 BELSLY BLVD
Second Line :
City : MOORHEAD
State : MN
Zip : 56560-5055
Country : US
Telephone Number : 218-287-4338
Fax Number : 218-287-5928
Provider Business Practice Location Address
First Line : 423 GREAT OAK DR
Second Line :
City : WAITE PARK
State : MN
Zip : 56387-2507
Country : US
Telephone Number : 320-281-5305
Fax Number : 320-281-5306
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2017
Last Update Date : 07/12/2017

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Directions to “ ALISHA ANDERSON ” Practice Location

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