Provider Demographics
NPI:1669755682
Name:ANDERSEN, CAROLINE D (PA)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:D
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:415 E HARDING WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6118
Mailing Address - Country:US
Mailing Address - Phone:209-944-5750
Mailing Address - Fax:209-464-2684
Practice Address - Street 1:415 E HARDING WAY
Practice Address - Street 2:SUITE D
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6118
Practice Address - Country:US
Practice Address - Phone:209-944-5750
Practice Address - Fax:209-464-2684
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
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Provider Licenses
StateLicense IDTaxonomies
CAPA21726363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical