1730526112 NPI number — MRS. ANITA M. LEMON

Table of content: MRS. ANITA M. LEMON (NPI 1730526112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730526112 NPI number — MRS. ANITA M. LEMON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEMON
Provider First Name:
ANITA
Provider Middle Name:
M.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1730526112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5723 HOLIDAY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70812-2128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-200-6564
Provider Business Mailing Address Fax Number:
225-356-4127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2138 WOODDALE BLVD
Provider Second Line Business Practice Location Address:
BUILDING #B
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70806-1443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-200-6564
Provider Business Practice Location Address Fax Number:
225-356-4127
Provider Enumeration Date:
05/27/2013

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: 146D00000X , with the licence number:  2328018 , 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: 2328018 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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