Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 35.094249 | OH |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 35.094249 | OH |
NPI | 1437340304 |
---|---|
Provider Name | Kristy Ellen Anderson |
First Address | Livonia, MI 48150-1216 |
Second Address | Centerville, OH 45459-4816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 12/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8M2522 | BCBS (01) | TX |