Provider Demographics
NPI:1588829477
Name:PADGETT, ANITA JO (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:JO
Last Name:PADGETT
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 1:63 AMBROSE ST APT 5
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-1222
Mailing Address - Country:US
Mailing Address - Phone:585-458-9071
Mailing Address - Fax:
Practice Address - Street 1:63 AMBROSE ST APT 5
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-1222
Practice Address - Country:US
Practice Address - Phone:585-458-9071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261698164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse