Provider Demographics
NPI:1023059573
Name:ARTHUR, ANITA D (APRN)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:D
Last Name:ARTHUR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:D
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10299
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46851-0299
Mailing Address - Country:US
Mailing Address - Phone:574-546-1900
Mailing Address - Fax:574-546-1999
Practice Address - Street 1:2100 N MAIN ST STE 304
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-1877
Practice Address - Country:US
Practice Address - Phone:574-546-1900
Practice Address - Fax:574-546-1999
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013945363LF0000X, 363LG0600X
MI4704258002363LF0000X, 363LG0600X
IN71002375A363LF0000X, 363LG0600X
OHAPRN.CNP.026658363LF0000X, 363LG0600X
TX1028999363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71002375AOtherSTATE LICENSE
OHAPRN.CNP.026658OtherSTATE LICENSE
TN34842OtherSTATE LICENSE
TX1028999OtherSTATE LICENSE
KY3013945OtherSTATE LICENSE
MI4704258002OtherSTATE LICENSE