MEDICARE: JACQUELINE ANDERS FNP

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	363LF0000X	Family Nurse Practitioner	28157053A	IN

General Provider Information

NPI Number	:	1881075877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE ANDERS FNP

Provider Business Mailing Address
First Line	:	614 N MAIN ST
Second Line	:
City	:	NORTH WEBSTER
State	:	IN
Zip	:	46555-9364
Country	:	US
Telephone Number	:	574-834-7677
Fax Number	:

Provider Business Practice Location Address
First Line	:	614 N MAIN ST
Second Line	:
City	:	NORTH WEBSTER
State	:	IN
Zip	:	46555-9364
Country	:	US
Telephone Number	:	574-834-7677
Fax Number	:

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

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	10/01/2021

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