Provider Demographics
NPI:1023091394
Name:ANDERSEN, KIMBERLY A (CRNP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:A
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 HARRISBURG AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2964
Mailing Address - Country:US
Mailing Address - Phone:717-544-4495
Mailing Address - Fax:717-544-5954
Practice Address - Street 1:217 HARRISBURG AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2964
Practice Address - Country:US
Practice Address - Phone:717-544-4495
Practice Address - Fax:717-544-5954
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008054363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q02618Medicare UPIN
PA075250Medicare PIN