Provider Demographics
NPI:1508060484
Name:ANDERSON, JOELLEN (RN, ARNP)
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-8501
Mailing Address - Country:US
Mailing Address - Phone:563-568-4277
Mailing Address - Fax:
Practice Address - Street 1:700 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-1041
Practice Address - Country:US
Practice Address - Phone:563-387-1045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA071035163W00000X
IAJ071035363LG0600X
IAJ-071035363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care