Provider Demographics
NPI:1891705968
Name:HANDEVIDT, ANITA MARIE (RN CNP CNS)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:HANDEVIDT
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Gender:F
Credentials:RN CNP CNS
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Other - First Name:
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Mailing Address - Street 1:117 S SPRING ST
Mailing Address - Street 2:PO BOX 686
Mailing Address - City:LUVERNE
Mailing Address - State:MN
Mailing Address - Zip Code:56156-1916
Mailing Address - Country:US
Mailing Address - Phone:507-283-9511
Mailing Address - Fax:507-283-9514
Practice Address - Street 1:401 WEST ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1219
Practice Address - Country:US
Practice Address - Phone:507-847-2423
Practice Address - Fax:507-847-2422
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2017-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR0902409364S00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN236135300Medicaid
MN374M2HAOtherBCBS
MN164160OtherUCARE
MN374M2HAOtherBCBS