1184902330 NPI number — BREANN ELIZABETH ANDERSON M.D.

Table of content: (NPI 1689984676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184902330 NPI number — BREANN ELIZABETH ANDERSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
BREANN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184902330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SANFORD CLINIC
Provider Second Line Business Mailing Address:
1527 BROADWAY ST
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-762-0399
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N COLUMBIA ROAD, STOP 9037
Provider Second Line Business Practice Location Address:
UNIV OF NORTH DAKOTA DEPT OF SURGERY, SMHS RM 5107
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58202-9037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-777-3067
Provider Business Practice Location Address Fax Number:
701-777-2609
Provider Enumeration Date:
07/21/2011

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: 208600000X , with the licence number:  RL 12001 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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