London Andel

Key facts

NPI

1003554460

Entity type

Individual (NPI type 1)

Primary specialty

Behavior Technician 106S00000X

Practice address

4152 30TH Ave S
Fargo, ND 58104-8524

Phone

(701) 364-2663

NPI assigned

May 25, 2022

Sex

Female

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Anne Carlsen Center Physical Therapist · Jamestown, ND · NPI 1598930109
  NPD BEHAVIOR TECHNICIAN

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 25, 2022.

{
    "created_epoch": "1653436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653436800000",
    "number": "1003554460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4152 30TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048524",
            "telephone_number": "701-364-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4152 30TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048524",
            "telephone_number": "701-364-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDEL",
        "first_name": "LONDON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-25",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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