Provider Demographics
NPI:1801139852
Name:ANDERSON, ANDREA GENE (RN, BSN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:GENE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 SOUTH MAIN STREET
Mailing Address - Street 2:PRAIRIE RIVER HOME CARE
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55535
Mailing Address - Country:US
Mailing Address - Phone:320-587-5162
Mailing Address - Fax:320-234-7950
Practice Address - Street 1:246 SOUTH MAIN STREET
Practice Address - Street 2:PRAIRIE RIVER HOME CARE
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55535
Practice Address - Country:US
Practice Address - Phone:320-587-5162
Practice Address - Fax:320-234-7950
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR190673-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse