Provider Demographics
NPI:1669508404
Name:JUSTUS, LOUISE ANNE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:ANNE
Last Name:JUSTUS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:901 KIMOLE LN
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1491
Mailing Address - Country:US
Mailing Address - Phone:517-263-6140
Mailing Address - Fax:517-265-6796
Practice Address - Street 1:901 KIMOLE LN
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1491
Practice Address - Country:US
Practice Address - Phone:517-263-6140
Practice Address - Fax:517-265-6796
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003453363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM35150060Medicare PIN