Individual
CARRIE L ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20952 E 12 MILE RD STE 200, SAINT CLAIR SHORES, MI 48081-3203
(586) 771-4820
(586) 771-6620
Mailing address
20952 E 12 MILE RD STE 200, SAINT CLAIR SHORES, MI 48081-3203
(586) 771-4820
(586) 771-7960
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209012068
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704411664
PROFESSIONAL LICENSE
MI
Enumeration date
11/18/2014
Last updated
09/13/2024
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