Individual
JEFFREY C ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1069 SUMMERS DR STE B, REXBURG, ID 83440-5335
(208) 607-9816
(208) 549-7883
Mailing address
1069 SUMMERS DR STE B, REXBURG, ID 83440-5335
(208) 607-9816
(208) 549-7883
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
NP-1314A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2283927
—
WA
Enumeration date
07/25/2013
Last updated
03/19/2025
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