Provider Demographics
NPI:1619415866
Name:ANDERSON, ILANA C (CPNP)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:C
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:ILANA
Other - Middle Name:A
Other - Last Name:CROCKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 CHILDRENS LN
Mailing Address - Street 2:PEDIATRIC CRITICAL CARE UNIT
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1910
Mailing Address - Country:US
Mailing Address - Phone:757-668-7331
Mailing Address - Fax:757-668-7537
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:PEDIATRIC CRITICAL CARE UNIT
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7331
Practice Address - Fax:757-668-7537
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174511363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics