Provider Demographics
NPI:1164182473
Name:ANDERSON, ADRIAN ALEXIS (APRN, NP-C)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:ALEXIS
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:APRN, NP-C
Other - Prefix:MR
Other - First Name:ADRIAN
Other - Middle Name:ALEXIS
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3003 ADAMS ST NE APT M60
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-8013
Mailing Address - Country:US
Mailing Address - Phone:708-606-8523
Mailing Address - Fax:
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2719
Practice Address - Country:US
Practice Address - Phone:505-272-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM67058363LC0200X, 363LF0000X
CO0997231363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine