Individual provider · NPI-1

Caroline D Andersen, PA

Physician Assistant, Medical · Stockton, CA

NPI number1669755682
StatusActive
Last updated in NPPESSep 26, 2011

Details

NPI
1669755682
Entity type
Individual (NPI-1)
Name
Caroline D Andersen
Credential
PA
Sex
Female
Sole proprietor
No
Enumeration date
Sep 26, 2011
Last updated
Sep 26, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363AM0700X Physician Assistant, MedicalPA21726CAYes

Practice location

415 E Harding Way
Suite D
Stockton, CA 95204-6118

Phone 209-944-5750 · Fax 209-464-2684

Mailing address

415 E Harding Way
Suite D
Stockton, CA 95204-6118

Phone 209-944-5750 · Fax 209-464-2684

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