1841280427 NPI number — MRS. LUANNE ELIZABETH ROBERSON LOTR, CHT

Table of content: MRS. LUANNE ELIZABETH ROBERSON LOTR, CHT (NPI 1841280427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841280427 NPI number — MRS. LUANNE ELIZABETH ROBERSON LOTR, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERSON
Provider First Name:
LUANNE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LOTR, CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841280427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 E WORTHY ST
Provider Second Line Business Mailing Address:
BUILDING IV
Provider Business Mailing Address City Name:
GONZALES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70737-4232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-644-7044
Provider Business Mailing Address Fax Number:
225-644-4414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 E WORTHY ST
Provider Second Line Business Practice Location Address:
BUILDING IV
Provider Business Practice Location Address City Name:
GONZALES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70737-4232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-644-7044
Provider Business Practice Location Address Fax Number:
225-644-4414
Provider Enumeration Date:
10/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  Z10485 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 721282530RO . This is a "HUMANA PROVIDER #" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 2314145 . This is a "AETNA HMO PROVIDER #" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 4320208 . This is a "AETNA NON HMO PROVIDER #" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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