Provider Demographics
NPI:1164655536
Name:ANDERSON, ACHAMMA (APN)
Entity Type:Individual
Prefix:MRS
First Name:ACHAMMA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 LAS VEGAS BLVD N
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-0588
Mailing Address - Country:US
Mailing Address - Phone:702-657-3873
Mailing Address - Fax:702-636-0787
Practice Address - Street 1:3603 LAS VEGAS BLVD N
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-0588
Practice Address - Country:US
Practice Address - Phone:702-657-3873
Practice Address - Fax:702-636-0787
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN00091363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology