Provider Demographics
NPI:1700951779
Name:ANDERSON, KAROLINE S (MD)
Entity Type:Individual
Prefix:DR
First Name:KAROLINE
Middle Name:S
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16811 BURKE STREET
Mailing Address - Street 2:STE 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118
Mailing Address - Country:US
Mailing Address - Phone:402-573-7337
Mailing Address - Fax:
Practice Address - Street 1:16811 BURKE STREET
Practice Address - Street 2:STE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118
Practice Address - Country:US
Practice Address - Phone:402-573-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22712208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1201479OtherAMERICHOICE
NE03976OtherBCBS OF NE
NE1200766OtherAMERICHOICE
NE1201450OtherAMERICHOICE
IA1584284Medicaid
NE1201331OtherAMERICHOICE
NE244040OtherMIDLANDS CHOICE
NE1201366OtherAMERICHOICE
NE1201480OtherAMERICHOICE
IA0584284Medicaid
NE1201253OtherAMERICHOICE