Provider Demographics
NPI:1942684378
Name:ANDERSON, KALEEN
Entity Type:Individual
Prefix:
First Name:KALEEN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:STOCKETT
Mailing Address - State:MT
Mailing Address - Zip Code:59480-0118
Mailing Address - Country:US
Mailing Address - Phone:406-736-5830
Mailing Address - Fax:
Practice Address - Street 1:21 CRANE AVENUE
Practice Address - Street 2:
Practice Address - City:STOCKETT
Practice Address - State:MT
Practice Address - Zip Code:59480
Practice Address - Country:US
Practice Address - Phone:406-736-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT335187374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide