Provider Demographics
NPI:1225334345
Name:ANDERSON, BILLIE JO LYNN (RN)
Entity Type:Individual
Prefix:MISS
First Name:BILLIE JO
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33520 UNIVERSITY AVE NW
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-7670
Mailing Address - Country:US
Mailing Address - Phone:763-218-1554
Mailing Address - Fax:
Practice Address - Street 1:33520 UNIVERSITY AVE NW
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-7670
Practice Address - Country:US
Practice Address - Phone:763-218-1554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN196712-6163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse