Basic Information
| Provider Information | |||||||||
| NPI: | 1003883182 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | CHARA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 UNIVERSITY AVE W STE 110N | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551142001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516025309 | ||||||||
| FaxNumber: | 6512226786 | ||||||||
| Practice Location | |||||||||
| Address1: | 675 E NICOLLET BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553376749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528927190 | ||||||||
| FaxNumber: | 9528927956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 12/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | R126603-4 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 127465 | 01 | MN | UCARE | OTHER | 0413227 | 01 | MN | MEDICA | OTHER | 925677 | 01 | MN | AMERICA'S PPO | OTHER | 585814300 | 05 | MN | MEDICAID | HP29538 | 01 | MN | HEALTHPARTNERS | OTHER | 43941700 | 05 | WI | MEDICAID | 1021486 | 01 | MN | PREFERREDONE | OTHER | 406274400 | 05 | MD | MEDICAID | 47B02AN | 01 | MN | BLUE CROSS/BLUE SHIELD | OTHER |