Provider Demographics
NPI:1912269077
Name:ANDERSON, GINA ROSE (RN)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:ROSE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 JEAN LAFITTE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-4036
Mailing Address - Country:US
Mailing Address - Phone:504-278-7410
Mailing Address - Fax:504-278-7324
Practice Address - Street 1:3002 JEAN LAFITTE PKWY
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4036
Practice Address - Country:US
Practice Address - Phone:504-278-7410
Practice Address - Fax:504-278-7324
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARNO73117163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health