| Doctor Name: | NANCY R ANDERSON |
| NPI Number: | 1083677827 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | R079341-4 |
| Business Practice Address: | 1655 Beam Ave Suite 302 Maplewood, MN - 551091163 |
| Business Phone Number: | 6512327800 |
| Business Fax Number: | 6512327826 |
| Mailing Address: | 1655 Beam Ave, Suite 302 MAPLEWOOD |
| State: | MN |
| Postal Code: | 551091163 |
| Phone Number: | 6512327800 |
| Fax Number: | 6512327826 |
| NPI Enumeration Date: | 04/11/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | R079341-4 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |