Provider Demographics
NPI:1285232751
Name:ANDERSON, NATALIA LAVONNE
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:LAVONNE
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 1:2002 EMMET ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68110-1817
Mailing Address - Country:US
Mailing Address - Phone:402-306-0135
Mailing Address - Fax:
Practice Address - Street 1:2002 EMMET ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68110-1817
Practice Address - Country:US
Practice Address - Phone:402-306-0135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEREGISTRY1459251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health