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  7. NPI Record 1568837433

ADDIE ANDERSON
Complete NPI Record 1568837433
Licensed Practical Nurse in Berkley, MI

NPI Status: Active since December 03, 2015

Contact Information

2766 W 11 MILE RD
SUITE 2
BERKLEY, MI
ZIP 48072
Phone: (248) 542-2424
Fax: (248) 542-5621

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Second Line Business Practice Location Address
  14. Provider Business Practice Location Address City Name
  15. Provider Business Practice Location Address State Name
  16. Provider Business Practice Location Address Postal Code
  17. Provider Business Practice Location Address Country Code If outside U S
  18. Provider Business Practice Location Address Telephone Number
  19. Provider Business Practice Location Address Fax Number
  20. Provider Enumeration Date
  21. Last Update Date
  22. Provider Gender Code
  23. Healthcare Provider Taxonomy Code 1
  24. Provider License Number 1
  25. Provider License Number State Code 1
  26. Healthcare Provider Primary Taxonomy Switch 1
  27. Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1568837433. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1568837433
The city name in the mailing address of the provider being identified.
Entity Type Code: 1
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider First Name: ADDIE
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider First Line Business Mailing Address: 15848 ARDMORE ST
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address City Name: DETROIT
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider Business Mailing Address State Name: MI
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Mailing Address Postal Code: 482273307
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Mailing Address Country Code If outside U S : US
The city name in the location address of the provider being identified.
Provider Business Mailing Address Telephone Number: 2485422424
The State code in the location of the provider being identified.
Provider Business Mailing Address Fax Number: 2485425621
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider First Line Business Practice Location Address: 2766 W 11 MILE RD
The country code in the location address of the provider being identified.
Provider Second Line Business Practice Location Address: SUITE 2
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address City Name: BERKLEY
The fax number associated with the location address of the provider being identified.
Provider Business Practice Location Address State Name: MI
The date the provider was assigned a unique identifier (assigned an NPI).
Provider Business Practice Location Address Postal Code: 480723033
The date that a record was last updated or changed.
Provider Business Practice Location Address Country Code If outside U S : US
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Provider Business Practice Location Address Telephone Number: 2485422424
The first name of the authorized official.
Provider Business Practice Location Address Fax Number: 2485425621
The middle name of the authorized official.
Provider Enumeration Date: 12/3/2015
The title or position of the authorized official.
Last Update Date: 12/3/2015
The 10-position telephone number of the authorized official.
Provider Gender Code: F
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Taxonomy Code 1: 164W00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 4703056316
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: MI
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Sole Proprietor: Y
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No