Mary Lynn Anderson, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

VN205279 Issued in CA

Practice address

311 Oceanside Blvd SPC 49
Oceanside, CA 92054-5130

Phone

(760) 803-0296

NPI assigned

Oct 21, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mary Lynn Pettersen Former name

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": "1603238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1396344222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 OCEANSIDE BLVD SPC 49",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920545130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 OCEANSIDE BLVD SPC 49",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920545130",
            "telephone_number": "760-803-0296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "MARY",
        "middle_name": "LYNN",
        "credential": "LVN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-21",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN205279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "PETTERSEN",
            "middle_name": "LYNN",
            "credential": "LVN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Annaliese Andersen
• Alaina Anderson
• Devin Anderson, FNP
• Erin Anderson, MSW
• Janelle Anderson
• Rachel Ann Anderson, RN, MSN, FNP
• Robin Marie Anderson, RN
• Sherilyn Jean Anderson
• Stacy Ann Anderson, RN
• Tisa Lynn Anderson, L.AC., DIPL.AC.

• Licensed Vocational Nurse in Oceanside, CA
• Providers in Oceanside, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; 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.