Individual
TIM ANDERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
555 WARREN RD, ITHACA, NY 14850-1862
(607) 257-1555
Mailing address
555 WARREN RD, ITHACA, NY 14850-1862
(607) 257-1555
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
645303
NY
Other
Enumeration date
04/29/2024
Last updated
04/29/2024
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