Individual
DALE ANDERSON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5050 N CLINTON ST, FORT WAYNE, IN 46825-5886
(260) 484-8551
(260) 482-5060
Mailing address
5052 N CLINTON ST, FORT WAYNE, IN 46825-5822
(260) 484-8551
(260) 482-5060
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
19504
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
28242030A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300012154
—
IN
Enumeration date
01/01/2015
Last updated
10/24/2018
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