Provider Demographics
NPI:1245979335
Name:ANDERS, JOHN (PSS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ANDERS
Suffix:
Gender:M
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 MILL ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1321
Mailing Address - Country:US
Mailing Address - Phone:774-954-1400
Mailing Address - Fax:775-954-1406
Practice Address - Street 1:704 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1321
Practice Address - Country:US
Practice Address - Phone:774-954-1400
Practice Address - Fax:775-954-1406
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPRSS-5117175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist