1457517799 NPI number — MS. CANDACE ADAIR ANDERSON BS,MT(ASCP)

Table of content: MS. CANDACE ADAIR ANDERSON BS,MT(ASCP) (NPI 1457517799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457517799 NPI number — MS. CANDACE ADAIR ANDERSON BS,MT(ASCP)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
CANDACE
Provider Middle Name:
ADAIR
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BS,MT(ASCP)
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:
1457517799
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 LAKE TRAVERSE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SISSETON
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57262-7046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-698-7606
Provider Business Mailing Address Fax Number:
605-698-3141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 LAKE TRAVERSE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SISSETON
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57262-7046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-698-7606
Provider Business Practice Location Address Fax Number:
605-698-3141
Provider Enumeration Date:
08/06/2008

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: 246ZI1000X , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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