Provider Demographics
NPI:1932854080
Name:ANDERSON, MARY DENEEN (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DENEEN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 AEGINA DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4835
Mailing Address - Country:US
Mailing Address - Phone:773-573-3503
Mailing Address - Fax:
Practice Address - Street 1:13 AEGINA DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-4835
Practice Address - Country:US
Practice Address - Phone:773-573-3503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024792363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health