Provider Demographics
NPI:1063843852
Name:ROWE, ANITA (RN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:ROWE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 LOOMIS AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-2517
Mailing Address - Country:US
Mailing Address - Phone:315-435-4618
Mailing Address - Fax:315-435-4415
Practice Address - Street 1:401 LOOMIS AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13207-2517
Practice Address - Country:US
Practice Address - Phone:315-435-4618
Practice Address - Fax:315-435-4415
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189770163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7924912179Medicaid