| NPI | 1003500653 |
|---|---|
| Former Name | CARRISSA LEE ANDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 10340) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 10340) |
| 163W00000X Registered Nurse (Licence: MN 2432155) | |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2025-11-05 |