Provider Demographics
NPI:1285685701
Name:ANDERSON, ANNE L (PA)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 N MAYFAIR RD
Mailing Address - Street 2:PLANK ROAD WALK IN CLINIC
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3462
Mailing Address - Country:US
Mailing Address - Phone:414-955-7299
Mailing Address - Fax:414-955-6282
Practice Address - Street 1:1155 N MAYFAIR RD
Practice Address - Street 2:PLANK ROAD WALK IN CLINIC
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3462
Practice Address - Country:US
Practice Address - Phone:414-955-7299
Practice Address - Fax:414-955-6282
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2016-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI944363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42999900Medicaid
005806261BOtherHUMANA
WI1285685701Medicaid
WI68086 1048Medicare PIN
S59946Medicare UPIN
WI1285685701Medicaid