Provider Demographics
NPI:1053749135
Name:ANDERSON, KARLA W (APN)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:W
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:809 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1337
Mailing Address - Country:US
Mailing Address - Phone:630-323-3540
Mailing Address - Fax:630-323-9079
Practice Address - Street 1:809 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1337
Practice Address - Country:US
Practice Address - Phone:630-323-3540
Practice Address - Fax:630-323-9079
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily