MEDICARE: ANITA MARIE HANDEVIDT RN CNP CNS

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	364S00000X	Clinical Nurse Specialist	R0902409	MN
2	363L00000X	Nurse Practitioner	R0902409	MN

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
2	374M2HA	OTHER	MN	BCBS
3	164160	OTHER	MN	UCARE

General Provider Information

NPI Number	:	1891705968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA MARIE HANDEVIDT RN CNP CNS

Provider Business Mailing Address
First Line	:	117 S SPRING ST
Second Line	:	PO BOX 686
City	:	LUVERNE
State	:	MN
Zip	:	56156-1916
Country	:	US
Telephone Number	:	507-283-9511
Fax Number	:	507-283-9514

Provider Business Practice Location Address
First Line	:	401 WEST ST
Second Line	:
City	:	JACKSON
State	:	MN
Zip	:	56143-1219
Country	:	US
Telephone Number	:	507-847-2423
Fax Number	:	507-847-2422

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	02/03/2017

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