MEDICARE: MRS. DIANE M ANDERSON FNPC

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	363L00000X	Nurse Practitioner	1505-033	WI

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	:	1801875364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANE M ANDERSON FNPC

Provider Business Mailing Address
First Line	:	143 SOUTH GIBSON STREET
Second Line	:
City	:	MEDFORD
State	:	WI
Zip	:	54451-1622
Country	:	US
Telephone Number	:	715-748-2121
Fax Number	:	715-847-2465

Provider Business Practice Location Address
First Line	:	143 SOUTH GIBSON STREET
Second Line	:
City	:	MEDFORD
State	:	WI
Zip	:	54451-1622
Country	:	US
Telephone Number	:	715-748-2121
Fax Number	:	715-748-7590

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	05/15/2012

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