Provider Demographics
NPI:1003883182
Name:ANDERSON, CHARA J (CNP)
Entity Type:Individual
Prefix:
First Name:CHARA
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE W STE 110N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-2001
Mailing Address - Country:US
Mailing Address - Phone:651-602-5309
Mailing Address - Fax:651-222-6786
Practice Address - Street 1:675 E NICOLLET BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6749
Practice Address - Country:US
Practice Address - Phone:952-892-7190
Practice Address - Fax:952-892-7956
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR126603-4363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN127465OtherUCARE
MN0413227OtherMEDICA
MN925677OtherAMERICA'S PPO
MN585814300Medicaid
MNHP29538OtherHEALTHPARTNERS
WI43941700Medicaid
MN1021486OtherPREFERREDONE
MD406274400Medicaid
MN47B02ANOtherBLUE CROSS/BLUE SHIELD
MNS94603Medicare UPIN
MNS94603Medicare UPIN
WI43941700Medicaid