MEDICARE: NIJA ANDERSON RN

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	163WG0100X	Gastroenterology Registered Nurse	RN.494519	OH

General Provider Information

NPI Number	:	1992652457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIJA ANDERSON RN

Provider Business Mailing Address
First Line	:	6338 STONEHAVEN LN
Second Line	:
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-3178
Country	:	US
Telephone Number	:	909-960-0090
Fax Number	:

Provider Business Practice Location Address
First Line	:	6338 STONEHAVEN LN
Second Line	:
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-3178
Country	:	US
Telephone Number	:	909-960-0090
Fax Number	:

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

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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