Provider Demographics
NPI:1386759819
Name:ANDERSON, MARIE CRISPIN (RN FNP)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:CRISPIN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:102 ELGIN PLACE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-3946
Mailing Address - Country:US
Mailing Address - Phone:601-925-0890
Mailing Address - Fax:
Practice Address - Street 1:1500 EAST WOODROW WILSON DR
Practice Address - Street 2:MEDICAL SERVICE ROUTING NUMBER 111A
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5199
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:601-364-1278
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR532606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily