Provider Demographics
NPI:1841705662
Name:ANDERSON, AMY L (CARE COORDINATOR)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CARE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10355 E PALMER WASILLA HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-8876
Mailing Address - Country:US
Mailing Address - Phone:907-746-3445
Mailing Address - Fax:
Practice Address - Street 1:10355 E PALMER WASILLA HWY STE 100
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8876
Practice Address - Country:US
Practice Address - Phone:907-746-3445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator