Provider Demographics
NPI:1720215148
Name:LOUIS, ANITA JOYCE (BSSC)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:JOYCE
Last Name:LOUIS
Suffix:
Gender:F
Credentials:BSSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12395 SE OATFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6954
Mailing Address - Country:US
Mailing Address - Phone:503-659-1813
Mailing Address - Fax:503-905-0769
Practice Address - Street 1:12395 SE OATFIELD RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6954
Practice Address - Country:US
Practice Address - Phone:503-659-1813
Practice Address - Fax:503-905-0769
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other