Basic Information
| Provider Information | |||||||||
| NPI: | 1841350998 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | LAURA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34120 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895334120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757475050 | ||||||||
| FaxNumber: | 7757475005 | ||||||||
| Practice Location | |||||||||
| Address1: | 3415 AMERICAN RIVER DR | ||||||||
| Address2: | STE A | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958645794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166480144 | ||||||||
| FaxNumber: | 9165610867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 07/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | G51523 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.