Anderson, Mary Kathleen
Anderson, Mary Kathleen is an individual health care provider with primary practice located at 480 Osborne Rd Ne , Fridley MN 55432-2773. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Anderson, Mary Kathleen can be contacted via phone (763) 785-4500.Contact Information
Primary practice address
480 Osborne Rd Ne
Fridley MN 55432-2773
Phone: (763) 785-4500
Fax: (763) 785-3329
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 10146 | Minnesota |
Profile Details
| NPI number | 1013080316 |
|---|---|
| LBN Legal business name | Anderson, Mary Kathleen |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 16th, 2006 |
| Last updated | Apr 3rd, 2012 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1013080316 | NPPES |
| Other | 625A6AN | BLUE CROSS OF MN | |
| Other | 138758 | BLUE CROSS OF MN | |
| Other | HP73373 | BLUE CROSS OF MN | |
| MEDICAID | 816420000 | BLUE CROSS OF MN |
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