Provider Demographics
NPI:1336728385
Name:ANDERSON, COLSON BERRY
Entity Type:Individual
Prefix:
First Name:COLSON
Middle Name:BERRY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 KEEAUMOKU ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3001
Mailing Address - Country:US
Mailing Address - Phone:808-859-8903
Mailing Address - Fax:
Practice Address - Street 1:1822 KEEAUMOKU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-3001
Practice Address - Country:US
Practice Address - Phone:808-859-8903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker