Individual
MARY KATHLEEN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
480 OSBORNE RD NE, FRIDLEY, MN 55432-2773
(763) 785-4500
(763) 785-3329
Mailing address
480 OSBORNE RD NE, FRIDLEY, MN 55432-2773
(763) 785-4500
(763) 785-3329
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10146
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
138758
UCARE
—
01
—
625A6AN
BLUE CROSS OF MN
—
05
—
816420000
—
MN
01
—
HP73373
HEALTHPARTNERS
—
Enumeration date
11/16/2006
Last updated
04/03/2012
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