Provider Demographics
NPI:1083261192
Name:ETIENNE, ANISHIA N (MMT PRACTIONER)
Entity Type:Individual
Prefix:
First Name:ANISHIA
Middle Name:N
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:MMT PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7516 BLUEBONNET BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1627
Mailing Address - Country:US
Mailing Address - Phone:225-605-5857
Mailing Address - Fax:
Practice Address - Street 1:911 RIDGEPOINT CT
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2898
Practice Address - Country:US
Practice Address - Phone:225-605-5857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9158225700000X, 225700000X
LA0000405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No405300000XOther Service ProvidersPrevention Professional