| NPI | 1376014084 |
|---|---|
| Former Name | TIMOTHY LYLE ANDERSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 10616) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 14478-33) |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2023-09-15 |