Provider Demographics
NPI:1841387792
Name:ANDERSON, JANE M (RN ARNP CNM)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN ARNP CNM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2124 LEAFLAUND PLACE
Mailing Address - Street 2:2
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515
Mailing Address - Country:US
Mailing Address - Phone:859-273-9714
Mailing Address - Fax:859-626-4298
Practice Address - Street 1:214 BOGGS LANE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475
Practice Address - Country:US
Practice Address - Phone:859-623-7312
Practice Address - Fax:859-626-4298
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY1038366163W00000X
KY771M367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse