MEDICARE: MRS. NANCY LEE ANDERSEN RN

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
1	163WS0200X	School Registered Nurse	RN072663	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528111291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY LEE ANDERSEN RN

Provider Business Mailing Address
First Line	:	857 S STILTON
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85208-7260
Country	:	US
Telephone Number	:	480-704-4010
Fax Number	:

Provider Business Practice Location Address
First Line	:	1728 W MAIN ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-6942
Country	:	US
Telephone Number	:	480-472-9359
Fax Number	:	480-472-9393

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/09/2007

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