Provider Demographics
NPI:1992378186
Name:ANDERSON, JANICE (CNA)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29547 HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:PORT SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70083-3039
Mailing Address - Country:US
Mailing Address - Phone:504-417-4329
Mailing Address - Fax:
Practice Address - Street 1:29547 HWY 11
Practice Address - Street 2:HWY 23 4TH FLOOR SUITE C
Practice Address - City:PORT SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70083-7008
Practice Address - Country:US
Practice Address - Phone:504-417-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA86-3845506171000000X, 374U00000X, 171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No171000000XOther Service ProvidersMilitary Health Care Provider
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11386651OtherCNA