Provider Demographics
NPI:1073950481
Name:MAES, ANISSA FRANCES MARIE
Entity Type:Individual
Prefix:MISS
First Name:ANISSA
Middle Name:FRANCES MARIE
Last Name:MAES
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 1:2710 MENLO DR
Mailing Address - Street 2:APT 1
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-3323
Mailing Address - Country:US
Mailing Address - Phone:775-671-7494
Mailing Address - Fax:
Practice Address - Street 1:2710 MENLO DR APT 1
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-3338
Practice Address - Country:US
Practice Address - Phone:775-671-7494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor