Provider Demographics
NPI:1306133095
Name:ANDERSON, DEBRA L (DNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:LEE
Other - Last Name:BRODERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:JOHNSON
Mailing Address - State:KS
Mailing Address - Zip Code:67855-0639
Mailing Address - Country:US
Mailing Address - Phone:620-492-1400
Mailing Address - Fax:620-492-1608
Practice Address - Street 1:404 N CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:KS
Practice Address - Zip Code:67855-0639
Practice Address - Country:US
Practice Address - Phone:620-492-1400
Practice Address - Fax:620-492-1608
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA108186163W00000X
IAA-108186363LF0000X
KS53-77305-031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse