Provider Demographics
NPI:1376780635
Name:PODINA, ANN LISA (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:LISA
Last Name:PODINA
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 1:11 VILLANOVA LANE
Mailing Address - Street 2:MRS. ANN PODINA
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746
Mailing Address - Country:US
Mailing Address - Phone:631-858-0684
Mailing Address - Fax:
Practice Address - Street 1:11 VILLANOVA LANE
Practice Address - Street 2:MRS. ANN PODINA
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746
Practice Address - Country:US
Practice Address - Phone:631-858-0684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY361034-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse