Provider Demographics
NPI:1861113920
Name:ANDERSON, CARLETTE RENEE
Entity type:Individual
Prefix:
First Name:CARLETTE
Middle Name:RENEE
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 1:90656 KOECHER RD
Mailing Address - Street 2:
Mailing Address - City:KERRICK
Mailing Address - State:MN
Mailing Address - Zip Code:55756
Mailing Address - Country:US
Mailing Address - Phone:218-460-9095
Mailing Address - Fax:
Practice Address - Street 1:413 COMMERCIAL AVE N
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072-4412
Practice Address - Country:US
Practice Address - Phone:320-245-9966
Practice Address - Fax:320-310-0433
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care