Provider Demographics
NPI:1467967448
Name:ANDERSON, MAGDALENE MARIE (NNP)
Entity Type:Individual
Prefix:
First Name:MAGDALENE
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35450 GOLDEN EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:81527-9445
Mailing Address - Country:US
Mailing Address - Phone:303-946-5036
Mailing Address - Fax:
Practice Address - Street 1:2525 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4518
Practice Address - Country:US
Practice Address - Phone:612-813-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10423781-44052080N0001X
MN7016363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine