Active NPI
Andrea Anderson
- Community Health Worker
- Las Vegas, NV
National Provider Identifier
1306365580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- CHW1-5611
- Practice address
- 1064 E Sahara Ave Ste H
Las Vegas, NV 89104-3220 - Phone
- (914) 299-5762
- NPI assigned
- Sep 19, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | CHW1-5611 | NV | Primary |
Addresses
Primary practice location
1064 E Sahara Ave Ste H
Las Vegas, NV 89104-3220
Mailing address
1064 E Sahara Ave Ste H
Las Vegas, NV 89104-3220
Phone (914) 299-5762
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHW1-5611 | NV | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731628800000",
"number": "1306365580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1064 E SAHARA AVE STE H",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891043220",
"telephone_number": "914-299-5762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1064 E SAHARA AVE STE H",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891043220",
"telephone_number": "914-299-5762"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "ANDREA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-19",
"last_updated": "2024-11-15",
"certification_date": "2024-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NV",
"license": "CHW1-5611",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.