Provider Demographics
NPI:1538998844
Name:ANDERSON, CAROLINE VICTORIA (FNP-C)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:VICTORIA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3882 JUNIATA ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-4814
Mailing Address - Country:US
Mailing Address - Phone:636-221-7515
Mailing Address - Fax:
Practice Address - Street 1:12200 WEBER HILL RD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1569
Practice Address - Country:US
Practice Address - Phone:314-842-5660
Practice Address - Fax:314-842-0169
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024029054363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner