Individual
MS. CONDRA M ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
26136 US HIGHWAY 59, FAIRFAX, MO 64446-8155
(660) 686-2211
(660) 686-2618
Mailing address
1806 N ALCO AVE, MARYVILLE, MO 64468-3818
(660) 582-8807
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
056910
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10001788900
COMMUNITY HEALTH PLAN
MO
05
—
429057508
—
MO
05
—
540492501
—
MO
Enumeration date
08/23/2006
Last updated
09/07/2010
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