Basic Information
| Provider Information | |||||||||
| NPI: | 1053313692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 6TH AVE N | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563032735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202525131 | ||||||||
| FaxNumber: | 3202402118 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 6TH AVE N | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563032735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202525131 | ||||||||
| FaxNumber: | 3202402118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 11/22/2011 | ||||||||
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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 | 207N00000X | 44506 | MN | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | HP35615 | 01 | HEALTH PARTNERS | OTHER | 142131 | 01 | U CARE | OTHER | 07 25 2002 | 01 | MMSI | OTHER | 1031188 | 01 | PREFERRED ONE | OTHER | 116094000 | 01 | MEDICAL ASSISTANCE | OTHER | 260J8AN | 01 | BCBS | OTHER | 0300206 | 01 | MEDICA HEALTH PLANS | OTHER | 070017209 | 01 | RR MEDICARE C11369 | OTHER | 116094000 | 05 | MN | MEDICAID | 1652898 | 01 | ARAZ GROUP AMERICA'S PPO | OTHER |