Provider Demographics
NPI:1124089271
Name:ANDERSON, SENNIE (FNP)
Entity type:Individual
Prefix:MRS
First Name:SENNIE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1319
Mailing Address - Country:US
Mailing Address - Phone:541-471-2701
Mailing Address - Fax:541-471-1166
Practice Address - Street 1:741 NE 6TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1556
Practice Address - Country:US
Practice Address - Phone:541-471-2701
Practice Address - Fax:541-471-1166
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR096006589N1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR082946Medicaid
OR106288Medicare ID - Type Unspecified
OR082946Medicaid