Individual
STACIE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
19270 SONOMA HIGHWAY, SONOMA, CA 95476
(707) 939-6070
Mailing address
911 LAKEVILLE ST # 116, PETALUMA, CA 94952-3329
(509) 999-3989
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
95029378
CA
363LG0600X
Gerontology Nurse Practitioner
Primary
95029378
CA
363LP2300X
Primary Care Nurse Practitioner
95029378
CA
Other
Enumeration date
05/22/2024
Last updated
05/22/2024
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