Provider Demographics
NPI:1003569641
Name:CARRY, ANTRAMESE (LVN)
Entity Type:Individual
Prefix:
First Name:ANTRAMESE
Middle Name:
Last Name:CARRY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 CORLEY ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-4221
Mailing Address - Country:US
Mailing Address - Phone:409-455-2762
Mailing Address - Fax:
Practice Address - Street 1:4670 CORLEY ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-4221
Practice Address - Country:US
Practice Address - Phone:409-455-2762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory