MEDICARE: MR. JEFFREY PAUL 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
1	163W00000X	Registered Nurse	RN290140	OH
2	163WC0400X	Case Management Registered Nurse	RN290140	OH
3	163WE0003X	Emergency Registered Nurse	RN290140	OH
4	163WG0000X	General Practice Registered Nurse	RN290140	OH
5	163WH0200X	Home Health Registered Nurse	RN290140	OH
6	163WI0500X	Infusion Therapy Registered Nurse	RN290140	OH
7	163WM0705X	Medical-Surgical Registered Nurse	RN290140	OH
8	163WW0000X	Wound Care Registered Nurse	RN290140	OH

General Provider Information

NPI Number	:	1801294558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY PAUL ANDERSON RN

Provider Business Mailing Address
First Line	:	1992 S GREGG RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44319-1306
Country	:	US
Telephone Number	:	330-329-6024
Fax Number	:

Provider Business Practice Location Address
First Line	:	1992 S GREGG RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44319-1306
Country	:	US
Telephone Number	:	330-329-6024
Fax Number	:

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

Provider Enumeration Date	:	12/11/2014
Last Update Date	:	12/11/2014

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