Provider Demographics
NPI:1548810484
Name:ANDERSON, LOU ANNA
Entity type:Individual
Prefix:
First Name:LOU
Middle Name:ANNA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 TOMAHAWK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-4931
Mailing Address - Country:US
Mailing Address - Phone:337-855-8390
Mailing Address - Fax:
Practice Address - Street 1:215 SOUTH STORER STREET
Practice Address - Street 2:#2255
Practice Address - City:IOWA,
Practice Address - State:LA
Practice Address - Zip Code:70647
Practice Address - Country:US
Practice Address - Phone:337-582-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care