Individual
TIA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
8717 W 110TH ST, SUITE 600, OVERLAND PARK, KS 66210-2144
(913) 428-2900
Mailing address
2401 GILLHAM RD, PROVIDER ENROLLMENT, KANSAS CITY, MO 64108-4619
(816) 701-5200
(816) 302-9939
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2010025473
MO
367500000X
Certified Registered Nurse Anesthetist
43557509011
KS
Other
Enumeration date
04/19/2017
Last updated
01/21/2019
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