Provider Demographics
NPI:1518229467
Name:ANDERSON, MARTHA ANN (RN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANN
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 1:650 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-5048
Mailing Address - Country:US
Mailing Address - Phone:318-283-0806
Mailing Address - Fax:
Practice Address - Street 1:650 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-5048
Practice Address - Country:US
Practice Address - Phone:318-283-0806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN106242163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health