| Doctor Name: | NICOLE ANDERSON |
| NPI Number: | 1245355049 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.A. |
| License Number: | 5601003919 |
| Business Practice Address: | 1400 W Ice Lake Rd Iron River, MI - 499359526 |
| Business Phone Number: | 9062656121 |
| Business Fax Number: | 9062652033 |
| Mailing Address: | 1400 W Ice Lake Rd, IRON RIVER |
| State: | MI |
| Postal Code: | 499359526 |
| Phone Number: | 9062656141 |
| Fax Number: | 9062652033 |
| NPI Enumeration Date: | 03/20/2007 |
| NPI Last Update Date: | 07/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 5601003919 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |