Provider Demographics
NPI:1659475093
Name:ANDERSON, EUGENIE J (WHNP)
Entity Type:Individual
Prefix:
First Name:EUGENIE
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:WHNP
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 847556
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7556
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 MEDICAL PKWY STE 419
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5015
Practice Address - Country:US
Practice Address - Phone:512-528-7385
Practice Address - Fax:512-528-7386
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX660897363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ69265Medicare UPIN
TX8F2929Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER