Provider Demographics
NPI:1811194202
Name:DUBOSE, ANITA
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:DUBOSE
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 1:5015 AUGUSTA CIR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8986
Mailing Address - Country:US
Mailing Address - Phone:979-690-9601
Mailing Address - Fax:979-690-6292
Practice Address - Street 1:5015 AUGUSTA CIR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8986
Practice Address - Country:US
Practice Address - Phone:979-690-9601
Practice Address - Fax:979-690-6292
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator