Individual
CARLY NICOLE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
522 VILAS ST, ONALASKA, WI 54650-2034
(608) 386-1740
Mailing address
522 VILAS STREET, ONALASKA, WI 54650
(608) 386-1740
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
308381-31
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35035700
—
WI
Enumeration date
02/20/2008
Last updated
02/20/2008
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