Healthcare Provider Details

I. General information

NPI: 1992378186
Provider Name (Legal Business Name): JANICE ANDERSON CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29547 HWY 11 HWY 23 4TH FLOOR SUITE C
PORT SULPHUR LA
70083-7008
US

IV. Provider business mailing address

29547 HIGHWAY 11
PORT SULPHUR LA
70083-3039
US

V. Phone/Fax

Practice location:
  • Phone: 504-417-4329
  • Fax:
Mailing address:
  • Phone: 504-417-4329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number86-3845506
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number86-3845506
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number86-3845506
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: