Provider Demographics
NPI:1700882792
Name:ANDERSON, ANN M (NP)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S BURG ST
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:NE
Mailing Address - Zip Code:69145-1313
Mailing Address - Country:US
Mailing Address - Phone:307-245-3666
Mailing Address - Fax:307-245-3656
Practice Address - Street 1:2301 HOUSE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3176
Practice Address - Country:US
Practice Address - Phone:307-637-1600
Practice Address - Fax:307-637-1694
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO82977363LF0000X
NE40468363LF0000X
WY21836.1074363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY119260400Medicaid
CO00538809Medicaid
NE276625Medicare ID - Type UnspecifiedPROVIDER ID
CO00538809Medicaid
J00030658Medicare ID - Type UnspecifiedPROVIDER ID
CO471698Medicare ID - Type UnspecifiedPROVIDER ID