Healthcare Provider Details

I. General information

NPI: 1013484286
Provider Name (Legal Business Name): ANISSA DUSENBERRY R.R.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANISSA WRIGHT R.R.T.

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7409 RALEIGH AVE
LUBBOCK TX
79424-2303
US

IV. Provider business mailing address

6923 INDIANA AVE PMB 258
LUBBOCK TX
79413-6111
US

V. Phone/Fax

Practice location:
  • Phone: 806-407-6560
  • Fax:
Mailing address:
  • Phone: 806-603-3434
  • Fax: 844-723-9729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number458493
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number99243
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: