Provider Demographics
NPI:1003823790
Name:ANDERSON, MARY JUREE (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JUREE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
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 830
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:OR
Mailing Address - Zip Code:97630-0032
Mailing Address - Country:US
Mailing Address - Phone:541-947-3541
Mailing Address - Fax:541-947-3546
Practice Address - Street 1:530 SUNSET
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:OR
Practice Address - Zip Code:97630-0032
Practice Address - Country:US
Practice Address - Phone:541-947-0989
Practice Address - Fax:541-947-2705
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse