Basic Information
| Provider Information | |||||||||
| NPI: | 1992181945 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | CAROLEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 SAINT CLAIR RIVER DR | ||||||||
| Address2: | |||||||||
| City: | ALGONAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480011802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107944982 | ||||||||
| FaxNumber: | 8107944407 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 MILITARY ST | ||||||||
| Address2: | |||||||||
| City: | PORT HURON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480605416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104888000 | ||||||||
| FaxNumber: | 8104888005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2015 | ||||||||
| LastUpdateDate: | 07/31/2015 | ||||||||
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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 | 4704200317 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.