Provider Demographics
NPI:1528580206
Name:ANDERSON, ARLESA (LPN)
Entity Type:Individual
Prefix:
First Name:ARLESA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 E GRIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:ATTAPULGUS
Mailing Address - State:GA
Mailing Address - Zip Code:39815-2424
Mailing Address - Country:US
Mailing Address - Phone:229-726-7599
Mailing Address - Fax:
Practice Address - Street 1:716 E GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:ATTAPULGUS
Practice Address - State:GA
Practice Address - Zip Code:39815-2424
Practice Address - Country:US
Practice Address - Phone:229-726-7599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5210158164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse