Provider Demographics
NPI:1235864786
Name:ANDERSON, CARRIE
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 PAULSON ST
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:ND
Mailing Address - Zip Code:58056-9024
Mailing Address - Country:US
Mailing Address - Phone:218-234-0180
Mailing Address - Fax:
Practice Address - Street 1:116 1ST ST E
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-4253
Practice Address - Country:US
Practice Address - Phone:701-952-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator