Basic Information
| Provider Information | |||||||||
| NPI: | 1700882792 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 S BURG ST | ||||||||
| Address2: | |||||||||
| City: | KIMBALL | ||||||||
| State: | NE | ||||||||
| PostalCode: | 691451313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072453666 | ||||||||
| FaxNumber: | 3072453656 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 HOUSE AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820013176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076371600 | ||||||||
| FaxNumber: | 3076371694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2005 | ||||||||
| LastUpdateDate: | 04/25/2017 | ||||||||
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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 | 363LF0000X | 82977 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 40468 | NE | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 21836.1074 | WY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 119260400 | 05 | WY | MEDICAID | 00538809 | 05 | CO | MEDICAID |