Provider Demographics
NPI:1861636011
Name:ANDERSON, RAMONA ANQUENETTE (CRNA)
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:ANQUENETTE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:PO BOX 771522
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38177-1522
Mailing Address - Country:US
Mailing Address - Phone:901-747-4624
Mailing Address - Fax:901-261-2542
Practice Address - Street 1:1601 NEW CASTLE RD
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2218
Practice Address - Country:US
Practice Address - Phone:870-261-0513
Practice Address - Fax:901-261-2542
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2015-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC002753367500000X
ARR063478163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1861636011OtherAETNA HEALTHCARE
AR1861636011OtherBAPTIST HEALTH SERVICE GROUP, INC.
AR1861636011OtherQUALCHOICE OF ARKANSAS
AR1861636011OtherTHREE RIVERS PROVIDER NETWORK
AR177920001Medicaid
AR5V169OtherBLUE CROSS BLUE SHIELD
AR1861636011OtherUNITED HEALTHCARE
AR1861636011OtherCIGNA
AR1861636011OtherPPO PLUS - ARKANSAS MANAGED CARE NETWORK
AR1861636011OtherNOVASYS / AM BETTER
AR13637618OtherCAQH DATABASE
AR1861636011OtherTRICARE SOUTH REGION
AR1861636011OtherHUMANA CHOICE CARE
AR1861636011OtherTHREE RIVERS PROVIDER NETWORK