Provider Demographics
NPI:1871730028
Name:ANDERSON, PATRICIA SUE (ANP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:SUE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8925 N MERIDIAN ST
Mailing Address - Street 2:SUITE100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2386
Mailing Address - Country:US
Mailing Address - Phone:317-218-2807
Mailing Address - Fax:800-591-3117
Practice Address - Street 1:8925 N MERIDIAN ST
Practice Address - Street 2:SUITE100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2386
Practice Address - Country:US
Practice Address - Phone:317-218-2807
Practice Address - Fax:800-591-3117
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002830A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200929840Medicaid
IN200929840Medicaid