MARY ANDERSON (FNP-C) – Family Nurse Practitioner, NPI 1144055674

MARY ANDERSON (FNP-C) is a healthcare provider. based in Waukon, Iowa. specializing in NURSE PRACTITIONER. They hold the professional credentials FNP-C. They hold a License No. 12050 (MN). The NPI Number for MARY ANDERSON (FNP-C) is 1144055674

Main info

Female
2 Years Of Experience
Accepts Medicare Assignment
Name
MARY ANDERSON (FNP-C)
NPI
1144055674
Phone
(563) 419-4709
Address
1207 2ND ST NW APT 101
Enumeration Date
4 September 2024
Last Update Date
4 September 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5635472021
Graduation Year
2024 (2 years ago)
PAC ID
3577096072
Group Practice PAC ID
1153238977
Professional Enrollment ID
I20241218003606
Address ID
IA521361064CR321XXWXXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness75
Years active:1State licenses:1Digital endpointsOther names

3,529 NURSE PRACTITIONER in IA

Provider Addresses for MARY ANDERSON (FNP-C)

  • 1207 2ND ST NW APT 101

    WAUKON, IA 521721020

    Phone: (563) 419-4709

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-12-18

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20241022005169INurse PractitionerMNTBD
I20241218003606INurse PractitionerIATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 52172)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1153238977View full group profile
NameSpecialtyState
O B S T E T R I C S/ G Y N E C O L O G YWI
Physician AssistantWI
Nurse PractitionerIA
Certified Nurse Midwife (Cnm)IA
Certified Nurse Midwife (Cnm)IA
Family PracticeCO
Mental Health CounselorMN
Nurse PractitionerIA
Nurse PractitionerIA
Nurse PractitionerMN

Reviews

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Frequently asked questions

What federal number belongs to MARY ANDERSON (FNP-C)?
The federal identifier for MARY ANDERSON (FNP-C) is NPI 1144055674.
Is MARY ANDERSON (FNP-C)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What kind of provider is MARY ANDERSON (FNP-C)?
The page reflects Family Nurse Practitioner for MARY ANDERSON (FNP-C). Clinical services aligned with this taxonomy classification.
Does MARY ANDERSON (FNP-C) practice in Iowa?
You will see Waukon, Iowa on file for MARY ANDERSON (FNP-C) alongside any extra practice locations.
What if Waukon, Iowa seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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