Provider Demographics
NPI:1033351267
Name:ANDERSON, JON N (CST/SA)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:N
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CST/SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E 28TH ST
Mailing Address - Street 2:SUITE 480
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1139
Mailing Address - Country:US
Mailing Address - Phone:612-863-1580
Mailing Address - Fax:612-863-1585
Practice Address - Street 1:920 E 28TH ST
Practice Address - Street 2:SUITE 480
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1139
Practice Address - Country:US
Practice Address - Phone:612-863-1580
Practice Address - Fax:612-863-1585
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant