Provider Demographics
NPI:1013935519
Name:ANDERSEN, JANE ELIZABETH (DPM)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELIZABETH
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 E FRANKLIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2825
Mailing Address - Country:US
Mailing Address - Phone:919-960-8858
Mailing Address - Fax:919-960-2882
Practice Address - Street 1:1506 E FRANKLIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2825
Practice Address - Country:US
Practice Address - Phone:919-960-8858
Practice Address - Fax:919-960-2882
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC403213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2430016Medicare PIN
NCU64049Medicare UPIN
NC2433347AMedicare ID - Type Unspecified