Provider Demographics
NPI:1114946829
Name:ANDERSEN, KATHLEEN TIGUE (APN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:TIGUE
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:T
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:4512 KIRKWOOD HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5123
Mailing Address - Country:US
Mailing Address - Phone:302-999-0137
Mailing Address - Fax:302-999-1042
Practice Address - Street 1:4512 KIRKWOOD HIGHWAY
Practice Address - Street 2:SUITE 202
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-999-0137
Practice Address - Fax:302-999-1042
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000293363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001127242Medicaid
DE0001127242Medicaid
DEP24477Medicare UPIN