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NPI Code Detail

MEDICARE: MS. DORA ANDERSON CFNP

MEDICARE: MS. DORA ANDERSON CFNP
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
1363LF0000XFamily Nurse PractitionerR701564MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932142502
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DORA ANDERSON CFNP
Provider Business Mailing Address
First Line : 3502 W NORTHSIDE DR
Second Line :
City : JACKSON
State : MS
Zip : 39213-4454
Country : US
Telephone Number : 601-362-5321
Fax Number : 601-362-5321
Provider Business Practice Location Address
First Line : 3502 W NORTHSIDE DR
Second Line :
City : JACKSON
State : MS
Zip : 39213-4454
Country : US
Telephone Number : 601-362-5321
Fax Number : 601-362-5321
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 07/09/2007

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