Provider Demographics
NPI:1356092308
Name:KOGER, ANNE ELISE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:ELISE
Last Name:KOGER
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 1:1905 W THOMAS ST STE D157
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2901
Mailing Address - Country:US
Mailing Address - Phone:985-687-8515
Mailing Address - Fax:
Practice Address - Street 1:1004 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5304
Practice Address - Country:US
Practice Address - Phone:985-687-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-11
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19D2248421291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory