Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | A-080599 | IA |
NPI | 1013160761 |
---|---|
Provider Name | Dorothy Jean Anderson |
First Address | Clinton, IA 52732-2241 |
Second Address | Clinton, IA 52732-2241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 28/10/2008 |