Provider Demographics
NPI:1427135771
Name:ANDERSEN, ANITA M (DO)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:M
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8911 E ORME ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-2423
Mailing Address - Country:US
Mailing Address - Phone:316-686-7884
Mailing Address - Fax:
Practice Address - Street 1:8911 E ORME ST
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-2423
Practice Address - Country:US
Practice Address - Phone:316-686-7884
Practice Address - Fax:316-686-0036
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05234902084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
052627Medicare ID - Type Unspecified
KSG11556Medicare UPIN