Provider Demographics
NPI:1962836874
Name:ANDERSON, TANERICHA LASHAY
Entity Type:Individual
Prefix:
First Name:TANERICHA
Middle Name:LASHAY
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 1:304 TEXAS AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-8529
Mailing Address - Country:US
Mailing Address - Phone:318-614-2318
Mailing Address - Fax:318-323-8110
Practice Address - Street 1:3200 JACKSON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39201
Practice Address - Country:US
Practice Address - Phone:318-614-2318
Practice Address - Fax:318-323-8110
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care