Provider Demographics
NPI:1568502672
Name:ANDERSON, BARBARA C (FNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:C
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-9470
Mailing Address - Country:US
Mailing Address - Phone:541-997-7134
Mailing Address - Fax:541-997-9650
Practice Address - Street 1:340 9TH ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9470
Practice Address - Country:US
Practice Address - Phone:541-997-7134
Practice Address - Fax:541-902-7533
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR090007482N1 FNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR090007482N1FNP-PPOtherSTATE LICENSE
OR053368Medicaid
ORS45309Medicare UPIN
OR053368Medicaid