Provider Demographics
NPI:1588096168
Name:ANDERSON, FELICIA (CNA)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:ABSAROKEE
Mailing Address - State:MT
Mailing Address - Zip Code:59001-0335
Mailing Address - Country:US
Mailing Address - Phone:406-927-2594
Mailing Address - Fax:
Practice Address - Street 1:33 GARDEN LANE
Practice Address - Street 2:
Practice Address - City:ABSAROKEE
Practice Address - State:MT
Practice Address - Zip Code:59001
Practice Address - Country:US
Practice Address - Phone:406-927-2594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT338267311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home