Anderson, Dale

Anderson, Dale is an individual health care provider with primary practice located at 5050 N Clinton St , Fort Wayne IN 46825-5886. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Anderson, Dale can be contacted via phone (260) 484-8551.

Contact Information

Primary practice address
5050 N Clinton St Fort Wayne IN 46825-5886
Phone: (260) 484-8551
Fax: (260) 482-5060
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 28242030A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 19504 Tennessee

Profile Details

NPI number 1750779591
LBN Legal business name Anderson, Dale
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 1st, 2015
Last updated Oct 24th, 2018 - about 7 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750779591 NPPES
Indiana MEDICAID 300012154

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