Provider Demographics
NPI:1093361388
Name:ANDERSEN, JOE V
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:V
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2889 W HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-4086
Mailing Address - Country:US
Mailing Address - Phone:417-229-4964
Mailing Address - Fax:
Practice Address - Street 1:2889 W HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-4086
Practice Address - Country:US
Practice Address - Phone:417-229-4964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider