Individual
BRANDON ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP
Contact information
Practice address
8050 TOWNSHIP LINE RD, INDIANAPOLIS, IN 46260-2478
(317) 415-8500
Mailing address
PO BOX 12812, BELFAST, ME 04915-4040
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
71005507A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201292680
—
IN
01
—
P01512410
MEDICARE RR PTAN
IN
Enumeration date
04/24/2015
Last updated
07/17/2017
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