Petula Anesia Anderson, REGISTERED NURSE

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

695171 Issued in NY

Practice address

20 Jerusalem Ave
3Rd Floor
Hicksville, NY 11801-4980

Phone

(516) 326-2020

Fax

(516) 719-7373

NPI assigned

Mar 25, 2015

Last updated

Mar 25, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427241600000",
    "number": "1093109209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 EMPIRE BLVD APT 2C",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112253252",
            "telephone_number": "347-417-6346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 JERUSALEM AVE",
            "address_2": "3RD FLOOR",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118014980",
            "telephone_number": "516-326-2020",
            "fax_number": "516-719-7373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "PETULA",
        "middle_name": "ANESIA",
        "name_prefix": "Mrs.",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-25",
        "last_updated": "2015-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "695171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Nurse in Hicksville, NY
• Providers in Hicksville, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.