Individual
MS. JANIS D. ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
314 CHARLES ST, BRAINERD, MN 56401-3208
(218) 855-1247
(218) 855-1248
Mailing address
645 2ND ST SW, PERHAM, MN 56573-1101
(218) 346-5384
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
5118
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12D08HE
BLUE CROSS BLUE SHIELD
MN
01
—
18DO8HE
BCBS DME
MN
01
—
411945552
FEDERAL ID
—
01
—
4308814
STATE ID
MN
01
—
4500073
MEDICA
MN
01
—
640003703
MEDICARE RAILROAD
MN
05
—
7314680-00
—
MN
Enumeration date
12/05/2006
Last updated
11/09/2009
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