Provider Demographics
NPI:1144290685
Name:ANDERSON, MARLYS A (WHCNP)
Entity type:Individual
Prefix:
First Name:MARLYS
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62150 200TH ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-6410
Mailing Address - Country:US
Mailing Address - Phone:320-693-3914
Mailing Address - Fax:
Practice Address - Street 1:310 BELLE AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5287
Practice Address - Country:US
Practice Address - Phone:507-387-5581
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR047228-5363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1016951OtherPREFERRED ONE
1067662OtherAMERICA'S PPO (ARAZ)
MN68G21ANOtherBCBS MN
33162OtherSIOUX VALLEY HEALTH PLAN
HP21391OtherHEALTH PARTNERS
07-03393OtherMEDICA
111463OtherUCARE
HP21391OtherHEALTH PARTNERS