Provider Demographics
NPI:1588643084
Name:ANDERSEN, LANA LOUISE (CRNFA)
Entity type:Individual
Prefix:MS
First Name:LANA
Middle Name:LOUISE
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39482
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-9482
Mailing Address - Country:US
Mailing Address - Phone:602-942-6166
Mailing Address - Fax:602-942-6188
Practice Address - Street 1:1802 W EL CAMINITO DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5257
Practice Address - Country:US
Practice Address - Phone:602-942-6166
Practice Address - Fax:602-942-6188
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN050320364SP2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperative
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ381707Medicaid