Provider Demographics
NPI:1457566820
Name:ANDERSON, ADA IOLA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ADA
Middle Name:IOLA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8654 HEAD HARBOUR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-6509
Mailing Address - Country:US
Mailing Address - Phone:410-437-4688
Mailing Address - Fax:410-222-7231
Practice Address - Street 1:1 HARRY S TRUMAN PKWY
Practice Address - Street 2:SUITE 231, MS 3103
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7042
Practice Address - Country:US
Practice Address - Phone:410-222-7108
Practice Address - Fax:410-222-7231
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP09365164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse