| Doctor Name: | MRS. KISHA TAMARA ANDERSON |
| NPI Number: | 1003881103 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN |
| License Number: | 26NN11131200 |
| Business Practice Address: | 151 Washington St Newark, NJ - 071023026 |
| Business Phone Number: | 9736223900 |
| Business Fax Number: | 9736221698 |
| Mailing Address: | 312 Stuyvesant Ave, NEWARK |
| State: | NJ |
| Postal Code: | 071063637 |
| Phone Number: | 9733995265 |
| Fax Number: | |
| NPI Enumeration Date: | 02/22/2006 |
| NPI Last Update Date: | 07/13/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | 26NN11131200 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |