Provider Demographics
NPI:1568906097
Name:ANDERSEN, ALISHA
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE MOUNTAIN
Mailing Address - State:NV
Mailing Address - Zip Code:89820-2136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:684 E 5TH ST
Practice Address - Street 2:
Practice Address - City:BATTLE MOUNTAIN
Practice Address - State:NV
Practice Address - Zip Code:89820-2136
Practice Address - Country:US
Practice Address - Phone:775-635-5753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator