Individual
LORIE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4748 REDBIRD ST, PORT ARTHUR, TX 77642-1870
(409) 332-1772
Mailing address
4748 REDBIRD ST, PORT ARTHUR, TX 77642-1870
(409) 332-1772
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
101000100
TX
171W00000X
Contractor
—
—
172A00000X
Driver
Primary
—
—
Other
Enumeration date
05/13/2014
Last updated
05/13/2014
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