Provider Demographics
NPI:1972669000
Name:ANDERSON, MANDY JO (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:JO
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MISS
Other - First Name:MANDY
Other - Middle Name:JO
Other - Last Name:HODNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:4024 VICKY ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-7020
Mailing Address - Country:US
Mailing Address - Phone:432-267-1876
Mailing Address - Fax:
Practice Address - Street 1:300 W VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5566
Practice Address - Country:US
Practice Address - Phone:432-263-7361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX664730163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse