Provider Demographics
NPI:1508401548
Name:ANDERSON, CHANDA RICHELE (DNP)
Entity Type:Individual
Prefix:DR
First Name:CHANDA
Middle Name:RICHELE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 E WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:PIERCE
Mailing Address - State:NE
Mailing Address - Zip Code:68767-1648
Mailing Address - Country:US
Mailing Address - Phone:402-750-8904
Mailing Address - Fax:
Practice Address - Street 1:3901 W NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4467
Practice Address - Country:US
Practice Address - Phone:402-371-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113018363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily