Provider Demographics
NPI:1154412518
Name:ANDERSON, MARIE K (FNP-C)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-2139
Mailing Address - Country:US
Mailing Address - Phone:701-352-4048
Mailing Address - Fax:
Practice Address - Street 1:1113 W 11TH ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-2139
Practice Address - Country:US
Practice Address - Phone:701-352-4048
Practice Address - Fax:701-922-1308
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR22236363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S24182Medicare UPIN
ND14161Medicare PIN