Theresa Anderson, N.P.
Individual provider Active NPI Adult Health Nurse Practitioner · Van Nuys, CA
NPI 1295101483 · NPPES record last updated Aug 11, 2015
Key facts
- NPI
- 1295101483
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- NP95002121 (CA)
- Practice address
- 13755 Victory Blvd
Van Nuys, CA 91401-2348 - Phone
- (818) 988-9825
- Fax
- (818) 988-9305
- NPI assigned
- Aug 11, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 13
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Open Door Community Health Centers
Practice addresses (Care Compare)
638 Main St
Ferndale, CA 95536-1157
Phone (707) 786-4028
Hospital & facility affiliations
- Providence at Home With Compassus Home Health, Humboldt
- Providence St Joseph Hospital
- Mad River Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190122003517 | CA | Practitioner - Nurse Practitioner | 5890032320 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP95002121 | CA | MD | Adult Health Nurse Practitioner |
| 95002121 | CA | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Angel Wings Medical Associates | Current |
Accepting new patients | |
| Open Door Community Health Centers | Current | Accepting new patients | |
| Open Door Community Health Centers | Current |
Accepting new patients | |
| Open Door Community Health Centers | Current | Accepting new patients | |
| Open Door Community Health Centers | Current |
Accepting new patients | |
| Open Door Community Health Centers | Current | Accepting new patients |
Locations
785 18th St
Arcata, CA 95521
Phone (707) 822-2481
770 10th St
Arcata, CA 95521
Phone (707) 826-8610
1275 8th St
Arcata, CA 95521
1130 W Olive Ave
Burbank, CA 91506
Phone (818) 645-5686
550 E Washington Blvd
Crescent City, CA 95531
Phone (707) 465-4636
2200 Tydd St
Eureka, CA 95501
Phone (707) 269-7051
1644 Central Ave
McKinleyville, CA 95519
Phone (707) 839-3068
Interoperability endpoints
- tanderson356788@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | NP95002121 | CA | Yes |
Addresses
Primary practice location
13755 Victory Blvd
Van Nuys, CA 91401-2348
Mailing address
13755 Victory Blvd
Van Nuys, CA 91401-2348
Phone (818) 988-9825
Other providers in Van Nuys, CA
- Alaysia Chantice Anderson
- Asa Maurice Anderson
- Daphna Anderson
- Kacie Anderson
- Marvin Glen Anderson Jr.
- Carlota Andon
- Daisy Andrade Channell
- Breanny Andrade
- Leslie Andrade
- Madalyn Andrade
All providers in Van Nuys, CA · Adult Health Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 11, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.