Provider Demographics
NPI:1487299178
Name:LOUIS, JOHANNE
Entity type:Individual
Prefix:
First Name:JOHANNE
Middle Name:
Last Name:LOUIS
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 1:730 NW 19TH ST APT WEST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-4006
Mailing Address - Country:US
Mailing Address - Phone:754-242-1726
Mailing Address - Fax:
Practice Address - Street 1:730 NW 19TH ST APT WEST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-4006
Practice Address - Country:US
Practice Address - Phone:754-242-1726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant