Provider Demographics
NPI:1043745516
Name:ANDERSON, CARIE ALISE LEILANI (NP, DNP)
Entity Type:Individual
Prefix:DR
First Name:CARIE
Middle Name:ALISE LEILANI
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25761 LAWTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3823
Mailing Address - Country:US
Mailing Address - Phone:530-321-7971
Mailing Address - Fax:
Practice Address - Street 1:701 GOLF VIEW DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9643
Practice Address - Country:US
Practice Address - Phone:541-494-1111
Practice Address - Fax:541-494-1099
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005662363LF0000X
OR201608771NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily