Provider Demographics
NPI:1164604799
Name:ANDERSON, CATHERINE A (APNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5993 COUNTY ROAD DD
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-8603
Mailing Address - Country:US
Mailing Address - Phone:715-824-6769
Mailing Address - Fax:
Practice Address - Street 1:5993 COUNTY ROAD DD
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-8603
Practice Address - Country:US
Practice Address - Phone:715-824-6769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3275363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36053100Medicaid
WI36053100Medicaid