Provider Demographics
NPI:1720765951
Name:KLEIN, ANNALIESE LOUISE (AP)
Entity Type:Individual
Prefix:MS
First Name:ANNALIESE
Middle Name:LOUISE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24850 BURNT PINE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-0905
Mailing Address - Country:US
Mailing Address - Phone:239-949-6002
Mailing Address - Fax:
Practice Address - Street 1:24850 BURNT PINE DR STE 2
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-0905
Practice Address - Country:US
Practice Address - Phone:239-949-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3481171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist