Provider Demographics
NPI:1124429089
Name:ANDERSON, PATRICIA (RN, DNP)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 UNION ST NE
Mailing Address - Street 2:
Mailing Address - City:CHATFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55923-1054
Mailing Address - Country:US
Mailing Address - Phone:507-421-2495
Mailing Address - Fax:
Practice Address - Street 1:625 UNION ST NE
Practice Address - Street 2:
Practice Address - City:CHATFIELD
Practice Address - State:MN
Practice Address - Zip Code:55923-1054
Practice Address - Country:US
Practice Address - Phone:507-421-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 137200-9163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health