Provider Demographics
NPI:1609528413
Name:BAME-ANDERSON, ALICIA (NP-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BAME-ANDERSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 97TH ST NW
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-4002
Mailing Address - Country:US
Mailing Address - Phone:763-370-7765
Mailing Address - Fax:
Practice Address - Street 1:1000 97TH ST NW
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-4002
Practice Address - Country:US
Practice Address - Phone:763-370-7765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8940363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily