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Individual

CHARLOTTE MARIE ANDERSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
510 4TH STREET S, FARGO, ND 58107
(701) 476-7200
Mailing address
PO BOX 143, BADGER, SD 57214
(605) 983-5087
(605) 983-4796

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
10156
ND
2084P0800X
Psychiatry Physician
MDR3657
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
13798
MEDICAID
ND
01
26728
BCBS
ND
Enumeration date
09/07/2006
Last updated
07/08/2007
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