Provider Demographics
NPI:1427658020
Name:ANDERSON, CATHY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:CATHY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 KRITTER CT
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-7899
Mailing Address - Country:US
Mailing Address - Phone:609-848-3880
Mailing Address - Fax:
Practice Address - Street 1:1004 S NEW RD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-3730
Practice Address - Country:US
Practice Address - Phone:609-652-4141
Practice Address - Fax:609-652-9939
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17452900363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health