| Doctor Name: | MRS. BENETTA S ANDERSON |
| NPI Number: | 1083998678 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NURSE PRACTITIONER |
| License Number: | 26N012455200 |
| Business Practice Address: | 81 Wall St Metuchen, NJ - 088402857 |
| Business Phone Number: | 7324521776 |
| Business Fax Number: | |
| Mailing Address: | 81 Wall St, METUCHEN |
| State: | NJ |
| Postal Code: | 088402857 |
| Phone Number: | 7324521776 |
| Fax Number: | |
| NPI Enumeration Date: | 09/30/2011 |
| NPI Last Update Date: | 09/30/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 26N012455200 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |