Provider Demographics
NPI:1841230166
Name:ANDERSON, DAVID M (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 NIGHTINGALE PL
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-7610
Mailing Address - Country:US
Mailing Address - Phone:515-432-4036
Mailing Address - Fax:
Practice Address - Street 1:800 OHIO ST
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-2824
Practice Address - Country:US
Practice Address - Phone:515-832-9400
Practice Address - Fax:515-832-9420
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA108154163W00000X
IAD108154367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07943OtherBLUE CROSS
IA6282749Medicaid
IA6282749Medicaid