Individual
AMY L ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
614 BAXTER ST, MARINETTE, WI 54143-2906
(715) 732-4643
Mailing address
614 BAXTER ST, MARINETTE, WI 54143-2906
(715) 732-4643
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27115-031
WI
Other
Enumeration date
07/14/2010
Last updated
07/14/2010
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