Provider Demographics
NPI:1417176694
Name:ANDERSEN, EVA E (NP)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:E
Last Name:ANDERSEN
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 1:180 MARBLE AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-3424
Mailing Address - Country:US
Mailing Address - Phone:914-941-7636
Mailing Address - Fax:914-923-0917
Practice Address - Street 1:180 MARBLE AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-3424
Practice Address - Country:US
Practice Address - Phone:914-769-7300
Practice Address - Fax:914-923-0917
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330910363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP11412Medicare UPIN
NY95N991Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER