Basic Information
| Provider Information | |||||||||
| NPI: | 1508048406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | MARI | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | C.R.N.F.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 WILL SCARLETT LN | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601209524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476956600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 745 FLETCHER DR | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601234747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476956600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2007 | ||||||||
| LastUpdateDate: | 12/03/2007 | ||||||||
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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 | 163WR0006X | IL | Y | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
No ID Information.