Provider Demographics
NPI:1760180772
Name:ANDERSON, MARIAN S (RN)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:S
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:S
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:14240 LONG GREEN DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2075
Mailing Address - Country:US
Mailing Address - Phone:410-330-4992
Mailing Address - Fax:
Practice Address - Street 1:14904 CLAUDE LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-5538
Practice Address - Country:US
Practice Address - Phone:301-879-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR210138163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health