Individual
MS. AVIA ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2660 11TH PL UNIT 405, KENOSHA, WI 53140-6404
(262) 412-0073
Mailing address
2660 11TH PL UNIT 405, KENOSHA, WI 53140-6404
(262) 412-0073
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10660
WI
Other
Enumeration date
07/24/2021
Last updated
07/24/2021
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