Provider Demographics
NPI:1548516073
Name:ANDERSON, WILLIAM LOUIS (FNP)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LOUIS
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:MR
Other - First Name:LOUIS
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:203 SUGAR TRACE DR
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-5166
Mailing Address - Country:US
Mailing Address - Phone:337-839-0371
Mailing Address - Fax:
Practice Address - Street 1:108 RUE LOUIS XIV
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5739
Practice Address - Country:US
Practice Address - Phone:337-235-8007
Practice Address - Fax:337-235-8008
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily