Provider Demographics
NPI:1780791327
Name:ANDERSON, DONNA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10657 TURQUOISE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-4110
Mailing Address - Country:US
Mailing Address - Phone:702-233-9248
Mailing Address - Fax:
Practice Address - Street 1:1341 S RAINBOW BLVD
Practice Address - Street 2:STE 201
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-9069
Practice Address - Country:US
Practice Address - Phone:702-363-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1119OtherLICENSE #