Healthcare Provider Details

I. General information

NPI: 1982765970
Provider Name (Legal Business Name): ANITA LOUISE SNOW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 HIGHWAY 951 EASTERN LA MENTAL HEALTH SYSTEM
JACKSON LA
70748
US

IV. Provider business mailing address

295 CARONDELET STREET
MANDEVILLE LA
70448
US

V. Phone/Fax

Practice location:
  • Phone: 225-634-0224
  • Fax: 225-634-0213
Mailing address:
  • Phone: 225-634-0200
  • Fax: 225-634-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberMD022776
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: