Provider Demographics
NPI:1013484286
Name:DUSENBERRY, ANISSA (RRT)
Entity Type:Individual
Prefix:
First Name:ANISSA
Middle Name:
Last Name:DUSENBERRY
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:ANISSA
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:6923 INDIANA AVE
Mailing Address - Street 2:PMB 258
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-6111
Mailing Address - Country:US
Mailing Address - Phone:806-603-3434
Mailing Address - Fax:844-723-9729
Practice Address - Street 1:7409 RALEIGH AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2303
Practice Address - Country:US
Practice Address - Phone:806-407-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4584932471C3402X
TX992432471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography