Provider Demographics
NPI:1386679199
Name:ANDERSON, NANCY L (CRNA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:2517 NE KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2409
Practice Address - Country:US
Practice Address - Phone:360-748-8632
Practice Address - Fax:360-748-8632
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000186367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT430072989OtherRAILROAD MEDICARE
AK430057469OtherRAILROAD MEDICARE
WA430024324OtherRAILROAD MEDICARE
ID430072800OtherRAILROAD MEDICARE
WA430057468OtherRAILROAD MEDICARE
ID430057465OtherRAILROAD MEDICARE
OR430057470OtherRAILROAD MEDICARE
WA430057466OtherRAILROAD MEDICARE
WAG000686620Medicare PIN
R12236Medicare UPIN
WAG000355065Medicare PIN
ORR107647Medicare PIN
ID1602185Medicare PIN
MT430072989OtherRAILROAD MEDICARE
OR430057470OtherRAILROAD MEDICARE
AK430057469OtherRAILROAD MEDICARE
ID430057465OtherRAILROAD MEDICARE
WAG000917185Medicare PIN
WA430057466OtherRAILROAD MEDICARE