Provider Demographics
NPI:1033285564
Name:ANDERSEN, MARY MARGARET (APRN, CNS, MSN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARGARET
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:APRN, CNS, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 SINGLETREE LN STE 204
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5397
Mailing Address - Country:US
Mailing Address - Phone:952-322-8532
Mailing Address - Fax:952-322-8513
Practice Address - Street 1:11800 SINGLETREE LN
Practice Address - Street 2:SUITE 204
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5328
Practice Address - Country:US
Practice Address - Phone:952-322-8532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR119098364SP0807X, 364SP0808X, 364SP0809X
MN79364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN33G27ANOtherBLUECROSS BLUESHIELD
MN41-2001259OtherSELECT CARE
MN62-51410OtherMEDICA
MN990991009372OtherPREFERRED ONE
MN12291815OtherVALUEPOINT (MULTIPLAN)
MN77745OtherHEALTH PARTNERS
MN588755100Medicaid
MN150212OtherUCARE
MN457962OtherVALUE OPTIONS
MN0411805759OtherFORTIS
MN1134583OtherARAZ