Provider Demographics
NPI:1225305121
Name:ALLALA-ETTIREDDY, ANITHA KUMARI
Entity Type:Individual
Prefix:
First Name:ANITHA
Middle Name:KUMARI
Last Name:ALLALA-ETTIREDDY
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 1:4660 BEECHNUT ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-1824
Mailing Address - Country:US
Mailing Address - Phone:713-521-0006
Mailing Address - Fax:
Practice Address - Street 1:4660 BEECHNUT ST
Practice Address - Street 2:SUITE 218
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-1824
Practice Address - Country:US
Practice Address - Phone:713-521-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-20
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX185505363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health