Provider Demographics
NPI:1255566741
Name:CHARON, ANIKA LATYSE
Entity type:Individual
Prefix:MS
First Name:ANIKA
Middle Name:LATYSE
Last Name:CHARON
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 1:100 RAVENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-7250
Mailing Address - Country:US
Mailing Address - Phone:318-537-4799
Mailing Address - Fax:318-323-6230
Practice Address - Street 1:2703 STERLINGTON RD APT 3
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2545
Practice Address - Country:US
Practice Address - Phone:318-537-4799
Practice Address - Fax:318-323-6230
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAECH36469072K172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker