Basic Information
| Provider Information | |||||||||
| NPI: | 1740469998 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | ARLYSS | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | RN, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3021 DANA ST | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947052073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252530435 | ||||||||
| FaxNumber: | 9252530430 | ||||||||
| Practice Location | |||||||||
| Address1: | 3021 DANA ST | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947052041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108452422 | ||||||||
| FaxNumber: | 9258457820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2007 | ||||||||
| LastUpdateDate: | 09/06/2016 | ||||||||
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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 | 265892 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.