Provider Demographics
NPI:1710111802
Name:RAYMOND, ANNE BERTHA (LPN)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:BERTHA
Last Name:RAYMOND
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 1:124 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-6537
Mailing Address - Country:US
Mailing Address - Phone:516-414-3573
Mailing Address - Fax:516-414-3573
Practice Address - Street 1:507 KIRKBY RD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3523
Practice Address - Country:US
Practice Address - Phone:516-437-9350
Practice Address - Fax:516-414-3573
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089692-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse