Provider Demographics
NPI:1114089232
Name:ANDRUSS, MERRITT M (ANP)
Entity type:Individual
Prefix:MS
First Name:MERRITT
Middle Name:M
Last Name:ANDRUSS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20133 COHEN DR
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8211
Mailing Address - Country:US
Mailing Address - Phone:907-957-1131
Mailing Address - Fax:907-780-6425
Practice Address - Street 1:4675 GLACIER HWY
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-9518
Practice Address - Country:US
Practice Address - Phone:907-321-5708
Practice Address - Fax:907-780-6425
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK566363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP2256Medicaid