Provider Demographics
NPI:1104949312
Name:ANDERSON, ANN M (RN,IBCLC)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1911
Mailing Address - Country:US
Mailing Address - Phone:201-385-3423
Mailing Address - Fax:
Practice Address - Street 1:139 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641-1911
Practice Address - Country:US
Practice Address - Phone:201-385-3423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR04602700163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant