Provider Demographics
NPI:1073643813
Name:ANDERSEN, ANDREA N
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:N
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10150 E VIRGINIA AVE
Mailing Address - Street 2:6-102
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1350
Mailing Address - Country:US
Mailing Address - Phone:303-360-7258
Mailing Address - Fax:
Practice Address - Street 1:2045 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5437
Practice Address - Country:US
Practice Address - Phone:303-743-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO111541163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
016335OtherKAISER-COMMERCIAL NUMBER