Provider Demographics
NPI:1578626594
Name:ANDERSON, ELAINE F (APRN, BC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:F
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WILMA'S WAY
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645
Mailing Address - Country:US
Mailing Address - Phone:508-432-8899
Mailing Address - Fax:
Practice Address - Street 1:830 COUNTY RD
Practice Address - Street 2:
Practice Address - City:POCASSET
Practice Address - State:MA
Practice Address - Zip Code:02559-2110
Practice Address - Country:US
Practice Address - Phone:508-564-9614
Practice Address - Fax:508-564-9668
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA169565364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ27071Medicare UPIN
MAANNSO739Medicare ID - Type Unspecified