Provider Demographics
NPI:1497239214
Name:ANDERSON, DANITA B
Entity Type:Individual
Prefix:
First Name:DANITA
Middle Name:B
Last Name:ANDERSON
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 1:6101 PINEMONT DR BLDG G
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-3218
Mailing Address - Country:US
Mailing Address - Phone:281-965-3630
Mailing Address - Fax:281-947-3120
Practice Address - Street 1:6101 PINEMONT DR STE G
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-3212
Practice Address - Country:US
Practice Address - Phone:281-965-3630
Practice Address - Fax:281-947-3120
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0183503747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX384738602Medicaid
TX385738602Medicaid