Provider Demographics
NPI:1528874005
Name:ANDERSON, ADRIENNE LEIGH (APRN)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:LEIGH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9209 YARDLEY TOWN DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-8095
Mailing Address - Country:US
Mailing Address - Phone:919-271-8813
Mailing Address - Fax:
Practice Address - Street 1:9209 YARDLEY TOWN DR
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-8095
Practice Address - Country:US
Practice Address - Phone:919-271-8813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCANDE-QAJ2C363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner