Provider Demographics
NPI:1134485923
Name:KING, ANNIE (RN)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:KING
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 1:980 MACE AVE
Mailing Address - Street 2:ROOM 219-A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-4604
Mailing Address - Country:US
Mailing Address - Phone:718-653-0835
Mailing Address - Fax:718-325-1632
Practice Address - Street 1:980 MACE AVE
Practice Address - Street 2:ROOM 219-A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-4604
Practice Address - Country:US
Practice Address - Phone:718-653-0835
Practice Address - Fax:718-325-1632
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY455304163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool