Provider Demographics
NPI:1427734136
Name:ANDERSON, JOELLE MARIE (RN)
Entity type:Individual
Prefix:
First Name:JOELLE
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11005 ALCOTT DR
Mailing Address - Street 2:
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56378-4702
Mailing Address - Country:US
Mailing Address - Phone:320-219-3318
Mailing Address - Fax:
Practice Address - Street 1:11005 ALCOTT DR
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-4702
Practice Address - Country:US
Practice Address - Phone:320-219-3318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN206952-8163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse