Individual
SOFIA MICHELLE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5177 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8000
(765) 446-7088
Mailing address
4835 GAGE WAY UNIT 105, LAFAYETTE, IN 47905-8994
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004219A
IN
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103779337
ANTHEM PTAN
IN
05
—
300084298
—
IN
01
—
815500619
MEDICARE PTAN
IN
01
—
Q00784156
RAILROAD PTAN
IN
Enumeration date
05/15/2023
Last updated
08/13/2024
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