| Doctor Name: | MS. MARY MARGARET ANDERSEN |
| NPI Number: | 1033285564 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, CNS, MSN |
| License Number: | R119098 |
| Business Practice Address: | 11800 Singletree Ln Suite 204 Eden Prairie, MN - 553445328 |
| Business Phone Number: | 9523228532 |
| Business Fax Number: | |
| Mailing Address: | 4677 142nd St W, APPLE VALLEY |
| State: | MN |
| Postal Code: | 551247716 |
| Phone Number: | 9523224354 |
| Fax Number: | |
| NPI Enumeration Date: | 11/27/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SP0807X |
| License Number: | R119098 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Psych/Mental Health, Child & Adolescent |
| Taxonomy Definition: | |