Provider Demographics
NPI:1003917998
Name:ANDERSEN, DOLORES M (RN)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:M
Last Name:ANDERSEN
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 1:5045 NADINE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-1333
Mailing Address - Country:US
Mailing Address - Phone:407-281-9061
Mailing Address - Fax:407-647-4251
Practice Address - Street 1:1555 HOWELL BRANCH RD
Practice Address - Street 2:B2
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1109
Practice Address - Country:US
Practice Address - Phone:407-644-6465
Practice Address - Fax:407-647-4251
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN395012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse