Provider Demographics
NPI:1609834951
Name:ANDERSON, JOANNE L (CRNA)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11022 N 28TH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5634
Mailing Address - Country:US
Mailing Address - Phone:602-424-7967
Mailing Address - Fax:
Practice Address - Street 1:19052 N R H JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4401
Practice Address - Country:US
Practice Address - Phone:623-975-2020
Practice Address - Fax:623-975-7005
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3378792367500000X
AZCRNA0836367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00275423Medicare PIN
FLU6729ZMedicare PIN