Provider Demographics
NPI:1477142859
Name:ANDERSON, CARYN MAE (RN)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:MAE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 HUNGRY HOLLOW RD SE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-9163
Mailing Address - Country:US
Mailing Address - Phone:423-476-0033
Mailing Address - Fax:
Practice Address - Street 1:2544 DALTON PIKE SE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37323-7157
Practice Address - Country:US
Practice Address - Phone:423-728-6400
Practice Address - Fax:423-728-6449
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN215642163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse