=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669685822
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOUISE G VANASSE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 05/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9539 HUFFMEISTER RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77095-2856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-855-9991
-----------------------------------------------------
Fax | 281-855-9992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6237 TERWILLIGER WAY
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77057-2803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-419-8201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0205X
-----------------------------------------------------
Taxonomy Name | Pediatric Endocrinology Physician
-----------------------------------------------------
License Number | J3693
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------