Provider Demographics
NPI:1699748715
Name:ANDERSON, MICHEL L (APRN)
Entity type:Individual
Prefix:MRS
First Name:MICHEL
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN
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 642120
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-8120
Mailing Address - Country:US
Mailing Address - Phone:402-493-4400
Mailing Address - Fax:402-493-8965
Practice Address - Street 1:8814 MAPLE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134
Practice Address - Country:US
Practice Address - Phone:402-493-4400
Practice Address - Fax:402-493-8965
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110637363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q30483Medicare UPIN
NE278349Medicare ID - Type Unspecified