Provider Demographics
NPI:1083907075
Name:ANDERSON, KAY LOUISE (RNC,CDE)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:LOUISE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RNC,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OVERLOOK RD
Mailing Address - Street 2:SUITE LL102
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3577
Mailing Address - Country:US
Mailing Address - Phone:908-522-5512
Mailing Address - Fax:908-522-5858
Practice Address - Street 1:11 OVERLOOK RD
Practice Address - Street 2:SUITE LL102
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3577
Practice Address - Country:US
Practice Address - Phone:908-522-5512
Practice Address - Fax:908-522-5858
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR08727000163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator