Provider Demographics
NPI:1578158093
Name:ANDERSON, THERESA MARIE (CNA)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25385 GERMANNA HWY
Mailing Address - Street 2:
Mailing Address - City:LIGNUM
Mailing Address - State:VA
Mailing Address - Zip Code:22726-2141
Mailing Address - Country:US
Mailing Address - Phone:540-219-7036
Mailing Address - Fax:
Practice Address - Street 1:305 WAKEFIELD DR
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508-5135
Practice Address - Country:US
Practice Address - Phone:301-377-9120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider