Provider Demographics
NPI:1396859328
Name:ANDERSON, ANNA L (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA-C
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 3988
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3988
Mailing Address - Country:US
Mailing Address - Phone:618-457-5200
Mailing Address - Fax:
Practice Address - Street 1:405 RUSHING DR
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3730
Practice Address - Country:US
Practice Address - Phone:618-993-3300
Practice Address - Fax:618-993-0262
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002351363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL143870Medicaid
174143OtherHEALTH LINK
043448OtherHEALTH ALLIANCE
080129117OtherRAILROAD MEDICARE
10019630OtherBCBS
IL214881Medicare Oscar/Certification
10019630OtherBCBS
080129117OtherRAILROAD MEDICARE