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NPI Code Detail

MEDICARE: MS. IMELDA MARY ANDERSON REGISTERED NURSE

MEDICARE: MS. IMELDA MARY ANDERSON REGISTERED NURSE
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 Nurse46028-030WI

General Provider Information

NPI Number : 1912074394
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. IMELDA MARY ANDERSON REGISTERED NURSE
Provider Business Mailing Address
First Line : 615 W MORELAND BLVD
Second Line :
City : WAUKESHA
State : WI
Zip : 53188-2462
Country : US
Telephone Number : 262-896-8435
Fax Number : 262-970-6670
Provider Business Practice Location Address
First Line : 615 W MORELAND BLVD
Second Line :
City : WAUKESHA
State : WI
Zip : 53188-2462
Country : US
Telephone Number : 262-896-8435
Fax Number : 262-970-6670
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 07/23/2007

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