Individual
SHIRLEY M ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCCA
Contact information
Practice address
1421 PREMIER DR, MANKATO CLINIC AT WICKERSHAM CAMPUS, MANKATO, MN 56001
(507) 625-1811
Mailing address
PO BOX 8674, 1230 E MAIN ST, MANKATO, MN 56002-8674
(507) 625-1811
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
6054
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117664
UCARE
MN
01
—
1758785
AMERICAS PPO
MN
01
—
29Q96AN
BCBS
MN
01
—
4511090
MEDICA
MN
05
—
586515800
—
MN
01
—
640003648
RR MEDICARE
—
01
—
HP40597
HEALTH PARTNERS
MN
01
—
NA2951023870
PREFERRED ONE
MN
Enumeration date
01/14/2006
Last updated
07/09/2020
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