Provider Demographics
NPI:1023395167
Name:ANNA, ROBERT C (RN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:ANNA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-2424
Mailing Address - Country:US
Mailing Address - Phone:716-759-4046
Mailing Address - Fax:
Practice Address - Street 1:302 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-2424
Practice Address - Country:US
Practice Address - Phone:716-759-4046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY495019163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse