Basic Information
| Provider Information | |||||||||
| NPI: | 1518006469 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 109 | ||||||||
| Address2: | |||||||||
| City: | NELIGH | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687560109 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 109 W 11TH ST | ||||||||
| Address2: | |||||||||
| City: | NELIGH | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687561065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4028875440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 08/25/2011 | ||||||||
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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 | 163WD0400X | 30226 | NE | N | Nursing Service Providers | Registered Nurse | Diabetes Educator | 363LG0600X | 111246 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 81051 | 01 | NE | BCBS NUMBER | OTHER |