Healthcare Provider Details

I. General information

NPI: 1720820905
Provider Name (Legal Business Name): ANELISE KATHERINE DIENER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 PERDIDO ST RM 4444
NEW ORLEANS LA
70112-1352
US

IV. Provider business mailing address

2021 PERDIDO ST RM 4444
NEW ORLEANS LA
70112-1352
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-4890
  • Fax:
Mailing address:
  • Phone: 504-568-4890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number342529
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: