Provider Demographics
NPI:1417115056
Name:SALICE, ANNE LANE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:LANE
Last Name:SALICE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 CROWN LAND LN
Mailing Address - Street 2:
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935-1211
Mailing Address - Country:US
Mailing Address - Phone:631-734-5734
Mailing Address - Fax:
Practice Address - Street 1:2120 CROWN LAND LN
Practice Address - Street 2:
Practice Address - City:CUTCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11935-1211
Practice Address - Country:US
Practice Address - Phone:631-734-5734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF350016363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care