Provider Demographics
NPI:1518383728
Name:WALDNER, ANNA L (PMHNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:L
Last Name:WALDNER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:L
Other - Last Name:WALDNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:402 EMMA DR
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57033-2061
Mailing Address - Country:US
Mailing Address - Phone:605-413-3089
Mailing Address - Fax:
Practice Address - Street 1:SEASONS CENTER FOR BEHAVIORAL HEALTH
Practice Address - Street 2:201 E 11TH STREET
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-0000
Practice Address - Country:US
Practice Address - Phone:712-262-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG151373363LP0808X
SDCP000995363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDCP000995OtherCNP NUMBER