Provider Demographics
NPI:1144556804
Name:ANDERSON, KATHERINE ALEXANDER (KATHERINE ANDERSON)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ALEXANDER
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:KATHERINE ANDERSON
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KATHERINE ANDERSON
Mailing Address - Street 1:PO BOX 7005
Mailing Address - Street 2:
Mailing Address - City:OCEAN PARK
Mailing Address - State:ME
Mailing Address - Zip Code:04063-7005
Mailing Address - Country:US
Mailing Address - Phone:207-615-4240
Mailing Address - Fax:
Practice Address - Street 1:68 MAIN ST
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7006
Practice Address - Country:US
Practice Address - Phone:207-615-4240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC339171100000X
NH160171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist