Provider Demographics
NPI:1992507933
Name:ANDERSON, ERNEST JOSEPH II
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:JOSEPH
Last Name:ANDERSON
Suffix:II
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21644 SHERWOOD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-5913
Mailing Address - Country:US
Mailing Address - Phone:313-658-4219
Mailing Address - Fax:
Practice Address - Street 1:21644 SHERWOOD AVE APT 1
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-5913
Practice Address - Country:US
Practice Address - Phone:313-658-4219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI376J00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker