Michelle Marie Anderson, NP
Individual provider Active NPI Nurse Practitioner · Sandpoint, ID
NPI 1922053883 · NPPES record last updated Feb 14, 2013
Key facts
- NPI
- 1922053883
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- NP-802A (ID)
- Practice address
- 1207 Michigan St
Suite C
Sandpoint, ID 83864-6608 - Phone
- (208) 265-2221
- Fax
- (208) 265-2229
- NPI assigned
- May 22, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Owned or controlled facilities with NPI records 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Bonner General Hospital |
Hospital | Corporate Director | Jul 1, 2016 |
| Bonner General Health |
Hospital | Corporate Director | Jul 1, 2016 |
| Bonner Community Hospice |
Hospice | Corporate Director | Jul 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070822000355 | ID | Practitioner - Nurse Practitioner | 4385736420 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP-802A | ID | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Idaho State University | Current |
Accepting new patients | |
| Idaho State University | Current |
Accepting new patients | |
| Idaho State University | Past | Accepting new patients | |
| Bonner General Hospital Inc. | Past |
Accepting new patients |
Locations
1311 E Central Dr
Rm 556
Meridian, ID 83642
1311 E Central Dr
Meridian, ID 83642
Phone (208) 373-1734
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | NP-802A | ID | Yes |
Addresses
Primary practice location
1207 Michigan St
Suite C
Sandpoint, ID 83864-6608
Mailing address
1207 Michigan St
Sandpoint, ID 83864-6608
Phone (208) 265-2221
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 807727100 | Medicaid | ID |
Other providers in Sandpoint, ID
- Amy Kathleen Ambridge
- F. Blake Ambridge
- American Oncology Partners, P.a.
- Ampersand Empire LLC
- Julie Anderson Dennis
- Steven E Anderson
- Andrew F. Martinssen DDS, Inc. PC
- Apollo Med Anesthesia PLLC
- Janie Arambarri
- Susan Christine Arima
All providers in Sandpoint, ID · Nurse Practitioner in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2013. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.