Provider Demographics
NPI:1346658218
Name:ANDERSON, JUSTIN ANDREAS (RN,DNP, CRNA)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ANDREAS
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:RN,DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1922
Mailing Address - Country:US
Mailing Address - Phone:612-961-0104
Mailing Address - Fax:
Practice Address - Street 1:225 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1922
Practice Address - Country:US
Practice Address - Phone:612-961-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-183208367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered