Provider Demographics
NPI:1780301143
Name:LOUIS, ANNETTE JEANNIE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:JEANNIE
Last Name:LOUIS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 CARROLL ST APT SUITE
Mailing Address - Street 2:
Mailing Address - City:PORT GIBSON
Mailing Address - State:MS
Mailing Address - Zip Code:39150-2102
Mailing Address - Country:US
Mailing Address - Phone:601-642-9400
Mailing Address - Fax:
Practice Address - Street 1:406 CARROLL ST APT SUITE
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-2102
Practice Address - Country:US
Practice Address - Phone:601-642-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS868861251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care