Provider Demographics
NPI:1801158761
Name:ANDERS, ONITISHA V (NP)
Entity type:Individual
Prefix:MISS
First Name:ONITISHA
Middle Name:V
Last Name:ANDERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6940 QUARTER HORSE DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27370-7864
Mailing Address - Country:US
Mailing Address - Phone:989-737-7620
Mailing Address - Fax:
Practice Address - Street 1:3821 FORRESTGATE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2930
Practice Address - Country:US
Practice Address - Phone:336-448-9100
Practice Address - Fax:336-778-7995
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC220231363L00000X
GARN222372363LA2200X
NC5008123363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health