Provider Demographics
NPI:1629384748
Name:LOUER, ANNA MELISSA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MELISSA
Last Name:LOUER
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 1:2322 SHERIFF DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-4211
Mailing Address - Country:US
Mailing Address - Phone:214-235-0326
Mailing Address - Fax:
Practice Address - Street 1:402 MARTHA ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-4344
Practice Address - Country:US
Practice Address - Phone:214-235-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11238377172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver