1871685792 NPI number — MRS. SANDY M ANDERSON APRN-BC

Table of content: MRS. SANDY M ANDERSON APRN-BC (NPI 1871685792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871685792 NPI number — MRS. SANDY M ANDERSON APRN-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
SANDY
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GORDON
Provider Other First Name:
SANDY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSN, MS, MS, APRN-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871685792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7271 N MAIN ST STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45415-2561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-991-0082
Provider Business Mailing Address Fax Number:
379-910-0089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7271 N MAIN ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45415-2561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-991-0082
Provider Business Practice Location Address Fax Number:
937-991-0089
Provider Enumeration Date:
09/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207QA0401X , with the licence number:  RN.254376-C0A1 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LC1500X , with the licence number: RN.254376-C0A1 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: RN.254376-COA1 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2388901 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000577058 . This is a "BCBS OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9939476 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".