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Individual

STACY ANDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PNP, CNS

Contact information

Practice address
13123 E 16TH AVE, AURORA, CO 80045-7106
(720) 777-1234
Mailing address
PO BOX 110429, AURORA, CO 80042-0429
(303) 493-7000

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4754
CO
364SP0200X
Pediatric Clinical Nurse Specialist
129811
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
20208715
CO
Enumeration date
08/14/2008
Last updated
02/01/2013
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