Provider Demographics
NPI:1376657858
Name:NORRIS, ANITA D (NP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:D
Last Name:NORRIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 18TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5389
Mailing Address - Country:US
Mailing Address - Phone:812-372-2245
Mailing Address - Fax:812-375-2156
Practice Address - Street 1:2325 18TH ST STE 220
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5389
Practice Address - Country:US
Practice Address - Phone:812-372-2245
Practice Address - Fax:812-375-2156
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000937A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200278020Medicaid
IN180340IMedicare ID - Type Unspecified
IN200278020Medicaid