Provider Demographics
NPI:1053036517
Name:ANDERSON, MARIDEL DE OCAMPO (BSN, RN, CWOCN)
Entity type:Individual
Prefix:
First Name:MARIDEL
Middle Name:DE OCAMPO
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BSN, RN, CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:MN
Mailing Address - Zip Code:56441-0074
Mailing Address - Country:US
Mailing Address - Phone:612-227-4095
Mailing Address - Fax:
Practice Address - Street 1:499 8TH ST NE
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:MN
Practice Address - Zip Code:56441-1550
Practice Address - Country:US
Practice Address - Phone:612-227-4095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN220404163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty