Provider Demographics
NPI:1952450702
Name:ANDERSON, PATRICIA RUTH (CNS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:RUTH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 TETON LANE
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001
Mailing Address - Country:US
Mailing Address - Phone:507-388-7488
Mailing Address - Fax:507-388-5680
Practice Address - Street 1:45 TETON LANE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-388-7488
Practice Address - Fax:507-388-5680
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR044736-2163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP09378Medicare UPIN
MN890000112Medicare ID - Type Unspecified