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NPI Code Detail

MEDICARE: DYAN I ANDERSON RN

MEDICARE:   DYAN I ANDERSON  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
1163W00000XRegistered Nurse123420CO

Other Identifiers

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

General Provider Information

NPI Number : 1568610780
Entity Type Code : Individual
Provider Name (Legal Business Name) : DYAN I ANDERSON RN
Provider Business Mailing Address
First Line : 128 MARKET ST
Second Line :
City : ALAMOSA
State : CO
Zip : 81101-2290
Country : US
Telephone Number : 719-587-1038
Fax Number :
Provider Business Practice Location Address
First Line : 8900 INDEPENDENCE WAY
Second Line :
City : ALAMOSA
State : CO
Zip : 81101-9412
Country : US
Telephone Number : 719-588-0786
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2008
Last Update Date : 08/29/2008

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Directions to “ DYAN I ANDERSON RN” Practice Location

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